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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. -
1) Example of Decision Support System used in the implementation
Regarding to my experiences, Project performance are based on Logical framework which are filled with target based on theory of change (desired outcome). Indicators are defined to measure the progress of project and adaption are made based on tracking the indicators. Indicators are also collected by using standardized form to measure the intended result. Evidence are generated based on data collection and use to decide the adaptive changes like project redesign, adding resources (budgets, Human resources, technical trainings).
2) Working well?
Data collection and information are essential to be reflective decision making. Without real time data, effective intervention can not be conducted by management level. Although Humans and Organization level are working well as per responsibilities, there is a constraint that is preventing to be functioning. It is technology. Lack of enough data affects in decision making.
3) Factors that influence the decision support system implementation
Lack of enough data is the critical issue for decision support. Secondly, Human resource and Organizational structure are also important vice visa. Enough HR and Good organizational management could enable to conduct enough data for correct decision making. -
Currently, most hospitals use the ICD standard to classify disease diagnosis. What would happen if the hospitals in the country do not use the ICD standard?
Without using ICD standard, Disease name will be vary based on medical officer for example, myocardial infarction and ischemic heart disease. Let assume that those are the same meaning and just different in recording disease. So, There will be two disease name in the database. It will impact in data compilation and will coded like two different diseases . And then, there will be inaccurate conclusion for clinical analysis and decision making. The consequences will be serially endless as impact of not using ICD (uniform) coding name. -
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1) What do you think about this finding?
Regarding to EHR six main causes of physician burn out, 1) EHRs’ documentation and related tasks, 2) EHRs’ poor design, 3) workload, 4) work overtime, 5) inbox alerts, and 6) alert fatigue.
2) Have you ever heard any complaints from health officers (or yourself) on using EMR?
This is also common in our implementation The main reason is poor design, interactive functions like auto filling, coding instead of filling long text, lack of trainees, continuous maintenance and system improvement.
3) Any suggestions to avoid or reduce this problem.
The resolving options are firstly EHR app design fixing upgrading to be user friendly and assisting interactive auto generated function. Then, conducting training for user and gathering feedback and continuous improvement before releasing the app. -
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In my opinion, e-Health is a set of terminology which is leading to enable health. It means set of functions based on services and data to produce effective, efficacy and efficient for using by customers. The fundamental is skeletal frame to provide health services. It should include interactive electronic data recording and generating system, health care service strategy and marketing plan to meet the desired output. There is an additional functions that is continuous monitoring and evaluation of the system to make adaption and decision making to meet the impact.
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In my opinion, Healthcare data could be considered to be fit in with seven Vs.
1) Volume: it is huge amount of data in a hospital. there might be million of pts records per year
2) Velocity: It is important to get real time data as well to use so timely updated is essential to upload.
3) Variety: There is also different type of data as pt record, lab result, stock data, financial data, logistic data with structured or unstructured data. That various type of healthcare data are needed to use in generating the impact of health care services.
4) Value: Data is precious when they use for multiple perspectives example value for money analysis, disease trending, medical research, making policy
5) Validity: It is one of core characteristic of data to record accurate data in health care. It means correct dosage of medicine, lab result, diagnosis etc.
6) Veracity: Health care data must be trustworthiness, good quality to apply in different purposes.
7) Visualization: It is also required to capture and generate the load of cases, financial growth, investment amount. Those visualized figures will help the management level to oversee the prominent points of health care setting to provide decision making for improvement. -
Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have experiences in health data management especially volunteer based report. There is a Maternal new born and child health (MNCH) project implemented with community based volunteers. The volunteers were trained MNCH basic skill and provide health services to the community. There are two type of volunteer which are Axillary Midwife (AMW) and Community Health worker (CHW). AMW provided maternal health services like Antenatal care, delivery, Post natal care and referral services if the cases are out of their manageable conditions. CHW provided child health care especially under five year diarrhea and pneumonia cases to get treatment as per protocol. They are responsible to report with specific format like AMW monthly, CHW Monthly report including drug consumption. Our project staff conduct supportive supervision to them and refill the stock monthly. Project staff collected their reports and transfer to data staff to conduct data entry. We used offline Microsoft access database with separate AMW and CHW data entry form. There are around 900 volunteers from 7 tsps. There are four data staff who conduct data entry and provide feedback to project staff if there was irrelevant facts to improve data quality. They reported the offline access database to data officer monthly. The data officer combine the tsp monthly report and conduct data analysis. Then prepared monthly reporting with formatted template. In the format, There is summary of cases like how many deliveries cases by AMW and how many under five diarrhea and pneumonia cases are treated by CHW. Moreover, We also have to monitor the stock usage to forecast the estimated consumption for upcoming quarters.How can this health informatics project help to improve the current practices?
– The data officer are responsible to monitor delivery information, case trending of diarrhea and pneumonia, drug consumption and forecasting for procurement. We can also use the health informatics like there was unusual case load in one village or surrounded villages from corresponded place. It is the alert of GE outbreak. When GE Outbreak occur, we reported to respective township health department and conducted outbreak response with basic health staff.
Are there any challenges or difficulties in implementing the project?
– There are numerous challenges while implementing the project. The first bottle necks was graphically remote area. It is difficult to reach and internet connection is not available to set online reporting. The result is delay reporting and responding. The information are known when project staff visited to their area. The second challenges is volunteer education. Since the area was hard to reach, there was scare resources to assign as a volunteer. Their literacy is primary level and they had difficulties to use registers and prepare report. It was the major impact in data quality. The project staff conducted closely supervision and coaching monthly to improve data quality. -
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Dear Bro,
Thanks for sharing this interesting case, I learned that although MFA was used to secure the system and then unauthorized request are blocked automatically. However, auto block function was not enable. It seems to double check or trail whether it does work or not as we always practice in our real work.
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As an attacker, He/she will find the vulnerability points of the system. There might be different based on structure of the system.
1) If the structure is web-based and control by user name. The first technique invading the system based on constructed web-based language. The another one will be user name and level of user privilege. If he/she gets the higher level user permission, the impact will be huge.
2) The second facts is based on assets. If asset are stolen or loss and transferred to attackers, they will try to hack or modify based on asset type.
3) IF the IT dataset is offline system, he/she might duplicate and misuses or selling the project to opponent’s company or agencies. -
1) I would rather recommend cloud server because physical server is more costly and require IT officer to maintain and fixing issue all the time. Could server is interactive and easily accessible with minimal effort. We can buy a cloud server with effective cost and can assure easily accessibility, mobility, data security and scalability. Moreover, maintenance and support that are taking responsible by service providers. We can spare our IT resource in fixing issues.
2) What kind of cloud computing service model would be most appropriate (SaaS, PaaS, IaaS)? Why?
SaaS is the most appropriate because it is software based and we can easily rely on provided services. It is more user friendly and effective ways. Cloud infrastructure are upgrading all the time based on consumers’ demands and experiences. We can make choice based on hospital requirements and can request to be user friendly model. -
Information plays vital role not only in outbreak situations but also in any emergency conditions. Immediate response or Specific information are importance to design outbreak response program. We can’t provide effective services without identifying the community needed or ground situations. In term of Flood response, We created real time data collection tools via KOBO platform to get the update data from the community. Our team conducted rapid need assessment and submitted data via link. Moreover, we also collected information from other local stakeholders to get the affected House hold list including status of safe drinking water. We could provide chlorination tablets to the affected household to prevent waterborne disease. Later on, By using the affected HH list, We also could provide latrines construction and hygiene awareness promotion as three month post-flood response project. As summary, Informatics is important to disseminate and advocate in outbreak/emergency situation.
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Regarding as a public health informatician, there are core skills that are enhancing to be a professional especially public health, IT skills, conceptual knowledge and critical thinking.
1) Public Health
I have foundation of public health knowledge because my bachelor focus on public health. I am also familiar with data collection, data processing and application in the output based projects.
2) IT skills,
I need to improve IT skills especially how dynamic database and dataset are constructed to generate the information in real time event.
3) Conceptual Knowledge and critical thinking
I also need to get the skill sets to create a road map or solution based on public health issue. I haven’t experience in resolving public health issue deeply. -
Hello Everyone, Nice to meet you. My name is Wai Phyo Aung and you can call me William as nickname. I am from Myanmar. I graduated from University of Community Health, Magway, Mayanmar. I work as a Humanitarian aid worker in an INGO and NGO especially in monitoring, evaluation and learning field. I hope this program will be effective my career development and skill in contribution of my work. Have a good day!!!
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