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Challenges & Simple Solutions for EMR,
1) Missing Data: Use consistent data entry rules and automatic checks to reduce gaps. Structured data set and control variables not to skip function in the application
2) Data Quality: Apply validation tools and regular audits to keep records accurate, EMR also needed to conduct quality check and feedback to improve the quality
3) Ethical & Confidential: Protect patient information with encryption and strict access controls like user level by level with password, admin, user, etc..
4) Volume: Store large datasets in scalable cloud systems that can expand easily and can delete or omit unnecessary information to reduce the size of dataset.
5) Variety: Standardize formats and use interoperability standards (like HL7 or FHIR) to combine different data types.
6) Velocity: Use real-time processing systems to handle fast data flow from devices and labs.
7) Training and supervision; Required skillset needed to train the all users and regular supportive supervision is recommended to improve the user capacity -
Good points of using EMR are below;
1) EMR makes patient information easy to find and it saves time and help the medical provider to make decision making because pt history and prescribed medicine, lab result can be accessible on the screen.
2) EMR reduces the loss of medical records and can get backup.
3) EMR improves continuity of care when patients move to other places and can print out or transfer to another health care unit if the information build up with interoperability.
4) EMR allows faster reporting and data sharing when needed.
5) EMR supports disease surveillance and health planning. The information can be extracted with code or name.
6) EMR reduces errors caused by poor handwriting especially transcription error.The bad points of EMR are;
1) EMR needs electricity and internet, which are often unreliable especially in Myanmar, the power supply is not stable and frequently black out.
2) EMR systems are costly to set up and maintain. It is needed to monitor by professional
3) Health workers need training to use EMR properly because it is likely to choose another information and can happen mis-interpretation.
4) EMR can increase workload if the system is not user‑friendly and the users has limited IT knowledge.
5) Patient data security and privacy can be at risk because it can leak at anytime
6) EMR systems may fail during conflict or power cuts. Some remote areas cannot use EMR at all especially in some hard to reach area of Myanmar. -
In Myanmar, the health system faces severe barriers because armed conflict, weak governance, lack of healthcare workforce and long‑standing underinvestment affect service delivery, especially in border and conflict‑affected areas. Since the military coup in February 2021, armed violence has damaged or destroyed health facilities, blocked transport routes, and created constant insecurity for patients and health workers, attacks or obstructions against health care and many hospitals forced to close or operate secretly. Border and ethnic areas are most affected because they are hard to reach, depend heavily on NGOs and ethnic health organizations, and have limited referral options after cross‑border movement to Thailand or India became restricted, leaving many patients without access to advanced care.
The shortage of human resources is critical, more than half of health workers have left public service or fled due to insecurity, arrest, or fear, with the worst gaps in rural and border townships. Policy and governance gaps further weaken the system, as there is no stable national health authority, health financing, medicine imports are restricted, and humanitarian access is often delayed or denied, preventing consistent service provision.
Integrated health research is also limited because conflict disrupts data collection, frontline staff lack time and training for operational research, and evidence from border and ethnic areas is poorly linked to national decision‑making.
In addition, digital health and information systems remain weak, as reporting is not usual, many facilities still rely on paper records, electricity and internet access are unreliable in border areas, and a comprehensive, functioning national digital health policy has not been fully implemented. -
I agree with first recommendation that key stakeholders in the health system to seek the agreement on the scale and nature of corruption in each system. It is the basic step to fight it because it is not possible to cut off without knowing the root cause of the problem. In the health care system, there are various type of professionals and we might not know the factors that are leading to corruption. Some professional may be hesitant to speak out their issues. So, Corruption may be normalize if they stay quiet. For the policy maker, it is important to sizing up the reasons. There should be strong policy to control the corruption not only with the patients but also within the staff. The polices are heard by all staff and let them know that the action are also imply to all staff if he/she disrupt it.
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Hello Everyone,
My Name is Wai Phyo Aung. You can call me my nickname as William. My degree is regarding to community health and Statistics is one of subjects in second yr. But it was in 2013 and I can’t barely remember at all. Currently, my professional is monitoring, evaluation, and learning field in non-government sector. Although I work with data, mostly use as descriptive method instead of inferential ways. However, my knowledge and experiences are not enough to encompass to apply. I am looking forward to learn from the lectures. -
If I were assigned to develop disaster recovery plan for organizational information system, I will conduct risk assessment first and conducted activation plan based on related weight of impact. In the activation phase, I will notify the staff and cost of effect, cause of default, restoration plan. In the restoring plan, There will be a living document that prescribed the detailed steps how it will be conducted. Training will be provided to the staff to aware and avoid the similar disaster later.
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If we implement the High Availability technology in the hospital information system (HIS),
Patients will get satisfactions in services, high quality and effective treatment because technology will facilitate in operation to be more easier in providing services. For example, medical appointments, accurate lab result, prescription in treatment.
For Hospital; There will be cost effective and greater financial revenue because technology can provide insightful information in financial management, medical services, HR management to support decision making for the further processes. -
IF I were a hospital director and had chance to manage the information management system. I will change to could computing system and will pick hybrid model because it has more flexibility, cost effective, security control. For patient information, we can keep in private to control the security. The other can be used in community. As benefit,
The operating system will be faster and can be analyzed the data to assist the decision making in treatment, lab result, investigation, payment in short time. It can save the time and workload as well. We can use the cost to allocate to another necessary area like medical research, modern equipment to upgrade the services. -
Has your computer or a computer in your workplace ever been attacked by a cyber threat? How did it happen?
In my previous workplace, We had experiences about receiving phishing mail to most of staff. It is similar message from center to enroll a mandatory course related to our work. I almost to enroll it. I noticed that their web address is wrong spelling and then I informed to our IT focal person. Luckily, My information was not provided to them. Our colleagues’ bank information were requested to get certificate from the course. The serial of remind mails were receiving and ads were also displaying on their screen. As resolution, IT focal blocked their web page and also reset the device. The email password of affected staff were changed. IT focal also ALERT information to all staff not to click that mail and to notify IT focal immediately when you found abnormal event or any suspect issue in our computer. -
I would like to develop a mobile app for patients that linked to private web server. There will be different interfaces based on user like doctors, patient, labs, receptionist, pharmacy, payment. Users will be defined and separated with specific accounts to avoid confusion. Doctor will update the treatment from their side. Patients can request the prescribed drug at Pharmacy counter with their unique ID. Payment will be charged based on visited date. Pt can also notify the issue if there is any worsen symptom and can visit to nearest linked hospital or emergency services requested via mobile app. The hospital management team can arrange a transportation to pick up the patient.
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Health problem facing in the world can be considered as two types; Non-communicable and communicable diseases.
1) Communicable diseases are highly infectious and become Public health emergency at anytime if we could not conduct intervention. As planning, There is essential to build effective surveillance system to notify immediately if there is a case or event. In the other hand, Well organized strategy is vital tool to conduct intervention.
2) In non-communicable disease; It is silently increasing especially in the low and middle income countries because of unhealthy lifestyle. It can be burden in financial and health care services. The key factor is to change healthy lifestyle and promoting health awareness to the civilian. It is not easy thing to change people behaviors. A good public health strategy is required to implement for behavioral changes. -
According to the principle of information security or CIA Triad, I have experienced using health information management system (HMIS) and also faced issues regarding confidentiality and availability.
Although the password is defined for each township to access the web-based server, it is not secured and easily accessible by other person. As consequence, Township health data is accessible by other unauthorized person.
The another issue is availability, server is frequently lagging and network instability. There was late reporting due to server maintenance.
Password should set according to standard list like number, special character, capital and small letters and not to share other person without permission.
For server lagging, Repaired time should be in not user using time like midnight or off days. -
In my previous work, I have done system in placement to be uniform and meet standard according to guideline. Let me briefly explain how change become, My position is responsible to be well functioning of Monitoring, Evaluation, Accountability and Learning (MEAL) in the implementing projects. The change result is to conduct MEAL specific orientation session in the project kick-off (starting session). Before that, there was not proper session regarding to how the project indicators will be measured in the project. As impact, the data quality and counting of indicator did not meet the desired target & definition. As strategy, I organized MEAL requirements (Log-frame, indicator definition, data collection tools, reporting channel, timeline) and developed necessary tools to use project by project. After that, I advocate the project manager with MEAL standard guideline to conduct MEL specific orientation by explanation the impact of not conducting result in previous projects. They discussed what benefit will get from the changes. I encourage them to initiate the change even though the steps and workload increase, the project performance will become better. Finally, I could conduct orientation session and set up MEL new function in the project. The project result improve and get recognition from the mangers as well.
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Based on my experience, Electronic health system is still having and needed to improve.
1) Hardware: There is not enough hardware and asset to change nationwide. Internet is not fully coverage.
It can be solved to extend network coverage and increase supply.
2) software: High performing software are required to operate the application. Regular update and change well-performance device. Suitable application to store large data set and analyze.
3) data: Paper hard data to soft data are needed to change. Data quality is also essential. Routine data quality check and assurance will be conducted after changing as electronic data.
4) process: Systematic procedure and well work flow will be defined and implemented.
5) people: Computer and digital literacy are needed to improve. Training and supervision will be provided to improve the capacity and performance. -
In my work, My role is mostly in mid-level management. I used social awareness and try to understand the team dynamics, strength and value of team members. I build up communication, mutual understanding and trust building with team members. I used affiliative leadership and coaching style. I care about team members emotions and growth by coaching to reach the team goal. But, it is not the best leading all the time. Sometimes, it does not work when team members are too diverse and emotional. The commanding and pacesetting leaderships are also unavoidable choice when immediate result and team goal are beyond the standard.
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After review the two leaders speech,
PM Lee (Signapore) speech contains six core principles of Crisis and Emergency Risk Communication (CERC) which are
1) Be First PM lees press the news after two week of outbreak, released the information every day
2) Be Right- shared right the information about what the nation prepare and conducting to deal with the situation
3) Be Credible- Well prepare and explore the information with fact (fast speed of infection) compared with SARS
4) Express Empathy- Advice the civilian and encourage what they should do, burden of health care staff
5) Promote Action- Postponed the unnecessary event to control the event, stock supplies, well plan to manage
6) Show Respect- Motivate to the community with actions, Consider all aspects of units ( Health staff, civilian, workforce), stable life, workforces, stay clamIn Trump Speech, The following three principle is more highlighted. The rest three (Be first, Express Empathy, Show respect) are faint.
2) Be Right- Smart action will prevent the spread, precautions
4) Express Empathy- Billing about vaccination, health cares expense, elderly consideration, not to travel crowded area
5) Promote Action- Restriction travel, declared PHEC, Information about how will conduct restriction, conduct screening, stay home
In summary, PM Lee communication is more persistent and inline with six core principle of CERC. -
The roadmap is structured with five core themes: 1) Team, 2) Transparency and Trust, 3) Technology, 4) Techquity, and 5)Transformation. Based on the articles, the five core themes are prescribed with the following perspective.
1) Team
Collaboration between stakeholders in health teams should be prioritized during pandemics and should promote the flow of data to improve population health.
2) Transparency and Trust
Timely data and information are necessary to address a pandemic, and digital health approaches must preserve rights to privacy and consent.
3) Technology
Public health systems should use the necessary technology to create and share health intelligence, collecting and using high-quality data in a timely fashion.
4) Techquity
Act to decrease inequities in digital health capability and access at individual, local, national, regional, and global levels, while embracing digital inclusion.
5) Transformation
Digital health should enable and empower people, and health care systems, to prevent and treat communicable diseases; sustain wellness; and prevent pandemics.
In Myanmar, According to my own perspective; It is needed to improve especially techquity and transformation themes rather than above three themes. In our system, digital heath record is not widely used in the hospital. Patient are used paper medical record and interoperability is not working well from hospital to another hospital. In the term of emergency, digital health system is main aspect to conduct effective intervention.
The second one that need to strengthen is transformation. Digital health system should encourage and widely used as nationally. It can be conducted by integrating technologies like EHRs, clinical decision support, and patient management systems into existing health system. -
Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
The list of diseases that declared as PHEIC as below;
1) In 2009; H1N1 Pandemic,
2) In 2014; Ebola virus in western Africa
3) In 2016, Zika Virus Epidemic
4) In 2019 & 2020; COVID-19 PandemicWhy do these outbreaks raise such concerns?
This outbreak raise such concerns based on the following four criteria;
1) impact on public health serious
2) unexpected or unusual event
3) significant spread to international
4) risk of any restriction in travel and tradeIn your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
Regarding to my opinion; According to world Malaria report 2024 by WHO In south east Asia including Myanmar, It found out one or more indigenous cases from 2022 to 2023, Malaria may lead to potentially PHEIC in the future if we could not control the cases especially case transmitted to boarder countries because the cases gradually increased after 2021. People are fleeing to cross boarder. In report, it described as ” In Thailand, bordering Myanmar, the number of reported indigenous cases has more than tripled between 2021 (2426 cases) and 2023 (9169 cases) (30), and reported imported cases to Thailand also significantly increased over the same period (2021–2023), from 800 to 7276 cases”
Sources for world malaria report 2024 by WHO:
https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024 -
1) ) Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
Single design limitation threatens the validity of sensitivity and representatives. In the articles, the main problem is under-reporting of AEFI cases. It can affect the sensitivity for being delaying of information, incomplete data. Regarding to representatives, data could not represent the whole cases because of under-reporting and may interpret as false case load. In impact, it might mis-regard as not an important issue.In the next six month, we can fix to improve real time reporting by establishing the electronic reporting system and can train the health staff to use the mobile reporting system. Moreover, we can train the health staff the technical competency to investigate and identify the AEFI cases in immunization.
2.) Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs, and list 2–3 indicators to detect impact from the intervention.
Regarding to low cost intervention;
Expected trade off; we can consider and ensure the system as the following;
1) Simplicity: reporting, data collection format should be simple and understandable for health staff. It should not be extra workload for them
2) Timeliness: Real time reporting is critical for AEFI cases. The defined channel must be reflected on ground situation. Delay report can not be used to develop effective response.
3) Data quality; The reported data must be fulfilled with standard data quality. Incomplete and missing data may take time and cause backward to interpret the cases.
we can set integrated reported indicator as 1) number of AEFI case in your health facilities; 2) Number of notified AEFI cases within 24hr in the monthly or quarterly report of Health information management system (HMIS) routine report.3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
It is absolutely needed to broad the early detection when newly vaccine is released in the community. It can be reverted when sensitivity and Predict value positive rate are dramatically decrease after analyzing the system, root causes, workload, data quality.
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How could information technology be applied to assist the outbreak investigation process?
Information technology could assist in many aspect of an outbreak investigation.
1) In verification and preparation step;
IT can facilitate in real time data collection of data to calculate the magnitude of it. It can support insightful information for verification of diagnosis, location, case trend, contact tracing, history taking.
2) In description of outbreak;
Advanced epidemiological expression can be conducted by commanding the statistical and mathematical calculation to describe the outbreak.
3) In Hypothesis and Testing;
It can also play as a pivotal role in testing the result. IT can provide fast and reliable information of the result. IT can generate the information based on imported data and requested command like seasonal trend, onset of case, sensitivity, Predict value positive (PVP).
4) In Response and Action;
IT is essential to be an effective response and action plan. The response and case data can be display as dashboard and it can also be used to communicate with the stakeholders in developing action plan. -
After reading the article, I learned about the importance of surveillance in responding pandemic disease COVID-19. The technology plays a pivotal role in surveillance. In the article, It highlighted the usages of technology in
1) digital epidemiological surveillance (web-based online syndromic , 2) Rapid case identification (febrile checking symptoms), 3) Interruption of community transmission (Digital contact tracing) , 4) Public communication (social media platform) and 5) Clinical care (teleconferencing). Among them,
Interruption of community transmission is my mind blowing tools. It works via smart phone based on low-power Bluetooth technology. In controlling of fast transmissible diseases, contact tracing and breaking the chain of transmission is key intervention to response. The technology can track the contact of positive patient by tracking the Bluetooth exposure range. It will alert to contact person to follow quarantine or test when his/her contact is becoming positive. It also can map the geo-point of the cases and additional measurement like lock-down, quarantine, medical service and other necessity services can provide to that place. -
1. How can surveillance help to detect and control the disease?
Surveillance is the effective method to detect case early because late identification may cause serious impact in dengue. It is highly infectious disease and can be public emergency condition. A good surveillance system can detect the cases and help to develop control measures as well.2. Should we conduct active or passive surveillance or both for the disease, why?
Active surveillance is the best option to control the disease because the disease is transmissible by mosquitos and can not wait to report the case to health facility. It will be late and outbreak will occur if we do not find the case actively in the community and do not conduct control measure like vector control, precautions.3. Which method should be best to identify cases, why?
Syndromic identification will be effective way to verify the case in active case detection. Health staff can easily confirm by checking common symptom of dengue in the community.a. Cases in medical facilities VS community
Case finding in community is the more effective method because there might be hidden case or incubation period in the community. Health staff can track by tracing contact history or detected place.b. Sentinel VS population-based surveillance
Population-based surveillance is the better choice to control the highly transmittible diseases because it can easily spread within community in the short time frame. The surveillance system should cover the whole population.c. Case-based VS aggregated surveillance
Case-based surveillance is also important in dengue cases because it is helpful to conduct control measure based on geographical area, family members, travel history, age, contact tracing and vector control.d. Syndromic VS laboratory-confirmed surveillance
Syndromic is quick and effective to report the suspected cases to facility. The further confirmation test can be conduct in the facility.4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Ongoing and real time dissemination tools is the good choice to share information faster within the health staff. It is not only hospital cases but also public health alarming. The case information should be shared interoperability between public health intervention workers and hospital care units. -
1) Should you give the data out?
• I will decide not to provide the requested data because it will violate the general principle of informatics ethnic privacy of information. Their requested data is too risky and easily detected the identity of patient like home address and contact list. It is totally against the informatics ethnic without consent.2) If you want to provide the data to them , what and
how will you do it?
• If regarding to benefit of research to prevent disease. I will discuss the national lead to get approval to share with them. After getting approval, I will ensure not to violate the ethical principle of informatics and will make a plan to share without personal disaggregated information. The individual home address and contact inform will be deleted and their representative geo point will be shared for the purpose of disease mapping. I will request the commitment from research team to follow the principle of accountability and the other general principles as well. -
Based on provided scenario;
What should I do?
• As a health information professional, I haven’t right to tell my friend about his husband information according to privacy of the patient. I must keep all patient information as confidential.Can you interfere with other people or family issue?
• No, I am not allowed to disrupt patient personal issue.
But, should your friend not know about this because she might be at risk?
How will you follow the fundamental principles about right to self-determination, doing good
and doing no harm to others? Isn’t it your obligation and the right of the subject to hold the information?
• Regarding to risk of transmission and harm to others, I can advocate the patient to follow precaution and procedure not to transmit the disease. I will encourage the patient to decide the family safety and protection the risk. -
Let me share the changes in way of distribution in flood response to ensure effectives of support to the affected community. I am responsible to report the data timely and make sure the accountability corner to get the feedback directly from the beneficiaries regarding distribution. I am the new role in the team, previously they distributed the items via village leader and get the data collection forms from them. I advocate the team the pro and cons of indirect distributions. It would be difficult to control the quality of data. Village leaders do not understand the procedure of distribution and have limitation to manage effectively. Moreover, there might be fraud case and complaints regarding to the response. I suggest to manage the distribution by the staff. I conducted the data collection form training and develop standard distribution criteria with the input of the management team. At the end, we could distribute the response items with our team effectively. We also keep this practice in the next emergency response. Learning from this scenario, the following are the reflection of change in ADKAR model;
1) Awareness: The team aware the cons of indirect distribution to the community. Data quality, fraud cases, bias, complaints will be impact if we could not supervise the village leaders.
2) Desire: Management Team and Staff agree to improve the quality of work. When they conduct in-person distribution, they well understand the ground condition and take care the importance step to be effective in work.
3) Knowledge: After training, staff gained required skill and technique to manage distribution.
4) Ability: Response team members are voluntarily organized. Staff actively participate in distribution by adjusting with their normal program task. Tools, plan, transportation are also arranged and supported to be effective.
5) Reinforcement: Real time reporting, beneficiaries’ gratitude, staff participation is the key to contribute successfully. Moreover, Management team provide necessary support like stakeholder coordination, technical guidance and appreciation to the response team.
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An example of a system in your organization.
In my previous work, VRS(Volunteer reporting system) was endorsed to access the primary health care services from community health workers. The paper based reporting form was used for reporting. The project staff were trained to supervise the quality of performance. The data are entered in offline ACCESS database and export as excel database to review the summary dashboard for decision making. It was well functioning for remote and hard to reach area where geographical and limited internet. However, there were a lot of difficulties in implementation. For the data quality,
Volunteers understanding affect in recording because some of volunteer were old age and illiterate to fill correctly.
The transportation cost and operation charges to get data and manage compared to online digital platform.
The program was funded by external donor and project could not proceed when grant did not extend after agreed timeline. The system could not operate because of no fund. The HR resources were also shortage especially in community level.
The model is better to take responsibility the government and should lead with basic health staff to improve basic health care services in community. -
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