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2019-11-24 at 11:35 pm #15866Dr.Watcharee ArunsodsaiParticipant
Again the same as previous case scenario, even I are in charge of national database collecting individual data in malaria among local and migrant patients, I could not give the individual data in details without the fundamental principle of information privacy and disposition. This is miss-conduct of the regulation for data protection in general principle of data integrity and confidentiality.
It would be permissible to give the aggregate data at village or sub-district level but if they request individual details, then we need to pass the approval of institutional ethical committee and get the informed consent from individual case. This process will ensure us not to violate any of general principles of medical informatics ethics, then we have the obligation to disclose the details of each single case. -
2019-11-24 at 11:12 pm #15865Dr.Watcharee ArunsodsaiParticipant
For the first question, If I were a health information professional, I should not tell my friend. This is miss-conduct of the regulation for data protection in general principle of data integrity and confidentiality. As Other friends said that during the diagnosis and treatment of HIV infected patients, the doctor should discuss with patients in many sessions of counseling to bring their sexual partners to check for HIV status. it would be permissible for the doctor to alert their partners in order for them to take steps to prevent transmission of infection even if the patient refuses to give consent to inform their own partners. Therefore, we can not interfere with other people or family issue. What I could do is just the recommendation of general health check-up and guidance to ensure the data safety because we are not the authorized person. Only this EMR is in the research protocol and get the permission from my friend’s husband to contact the partner after informed consent, then we have the obligation to do that.
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2019-11-24 at 8:56 pm #15855Dr.Watcharee ArunsodsaiParticipant
About the eHIS system, our organization tries to have appropriate change management. However, as I said before that during development of the system, we involved just only the hospital administrative board but did not involved with people from other facilities such as the nurses, phramcists, lab technicians, and also medical students and hospitalists etc. . The change management will be not easy as the hospital administration wishes.
For these change failure, I think it may be due to
A: Awareness
– Some of the people who get involved in the change, such as medical staff, nurses, and pharmacists, agreed to change to improve the quality of care. While major of end-user such as medical residents might not want to change, due to a lot more workload on them, especially for the in-patient care. Therefore the nurses, who currently have a lot of workloads, have to duplicate the work to fill in physician order entry especially the prescription and investigation orders instead of the physicians who wrote in the paper-based order.D: Desire
-According to a lot of workload for medical personnel in combination with, they don’t feel they will get more benefits form changing systems.K: knowledge
-We have a lot of people who get involved in this eHIS project, who do not have awareness and desire for this project, and also the training took place a very long period before the system was just implemented, people who just entry recently may lack of the hand-on knowledge of how the system operates.A: Ability
-Because of the user-unfriendly appearance of the eHIS project, a lot of end-users may need help at any time. The peoject manager fail to handle this situation, and end-users have to consult each other selves and can not give the feedback in timely manner. All of these brings an under-standard health delivery for their patients during that time and make a bad impression on this system.R: reinforcement
-The eHIS project lack of reinforcement to keep change in the hospital physician, nurses, hospitalists, pharmacists or IT staff to be ongoing. -
2019-11-24 at 8:26 pm #15854Dr.Watcharee ArunsodsaiParticipant
My hospital board have used both EMR and paper-based record from the vendor in Thailand. We did not develop ourselves. Despite this EMR have been developed, the hospital staff could not utilize it efficiently. Previously, staff in my hospital had used the electronic medical record merely for OPD patient for each visit registration, drug prescribing, and financial record but not IPD. When the patient comes to follow-up, the doctor needs to find out paper-based IPD records, nurses and physicians’ former and home-medicine prescription. It showed that even though EMR could be implemented in the other hospitals, my hospital and some other hospitals could not utilize it successfully. The reasons of system failure are staff had not been well trained enough before implemented the system and there is no re-evaluation on users’ ability. The system does not fully achieve the objectives of the users, however, the price was reasonable. The system may need to be upgraded and the technical support team may need to be educated and rebuild the system again as AGILE model.
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2019-11-24 at 6:39 pm #15853Dr.Watcharee ArunsodsaiParticipant
This eHealth project is benefit for the patient for their cost through self screening, and increase the active case to get the treatment. The patient also get the satisfaction for the privacy and confidentility as they can reduce the stigma that is one of the problem of TB management. I agree with Mvidhayagorn that you could integrate your eHealth project with Khun Chalermpol as bigger project as I think that early screening will improve the outcome if you can follow up the patient.
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2019-11-24 at 6:27 pm #15852Dr.Watcharee ArunsodsaiParticipant
Thank you for sharing your TB project. This eHealth project could benefit more in term of reducing the cost of the treatment for the patient who would like to continue their treatment across the border. They can save time, cost and can improve the satisfaction and outcome of the treatment. Do you have the integrated information of the adverse event of the anti-tuberculosis drugs and compliance of the patients or not? As I concerned is that MDR-TB are among the patient across the border.
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2019-11-24 at 11:50 am #15845Dr.Watcharee ArunsodsaiParticipant
In my hospital, we have a hospital information system (HIS) that can alert like a pop-up in the work flow in prescription and alert or reminder in laboratory results. As an example of Oseltamivir for pediatrician, it will show he pop-up for dosage for body weight, and others fr drug-drug interaction, over prescription for some drugs but not for drug allergy or adverse event yet.
The CDS is working well for pediatricians as dosage of prescription, but may disturb the workflow for internal Medicine clinician because of pop-up alert. The lab result is just reminder for the clinician for abnormal value but not linked with other clinical decision.
There are some factors that might influence the decision support system implementation in my organization. The CDSS needs more man power and also knowledgable persons including the stakeholders (more clinician). The design of the system should be more user friendly and not disrupt the workflow. We need something like order sets and info button as well.
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2019-11-23 at 4:46 pm #15798Dr.Watcharee ArunsodsaiParticipant
I also agree with Weerawan and others. ICD coding system is the international classification of diseases established by World Health Organization for reporting diseases and health conditions. It is the diagnostic classification aimed for local and national planning, public health policy, national resourcing assessment, and population research purposes. ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive, hierarchical fashion. ICD is used for monitoring of the incidence and prevalence of diseases, observing reimbursements and resource allocation trends, and keeping track of safety and quality guidelines. They also include the counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status, and external causes of disease.
If the hospitals in each country do not use the ICD standard, it will be difficult for health information exchange not only in one country but also international level in term of report and epidemiology eg.
– Storage, retrieval and analysis of health information for evidenced-based decision-making
– Sharing and comparing health information between hospitals, regions, settings and countries
– Comparing data set in the same location across different time periods -
2019-11-23 at 3:24 pm #15796Dr.Watcharee ArunsodsaiParticipant
As a clinician, I totally agree with these findings. In the old days, clinician writes down what they want to describe for each patient freely in the blank paper including the provisional diagnosis which may be not categorized into the diagnosis code . Moreover, most clinician can not remember the exact clinical diagnosis code. Writing down in the paper doesn’t take a lot of time and it can be finished at the worksite.
When the EMR era has come, all inputs into the systems come from typing into the computer and when we need to draw a picture it usually difficult to draw and label on the picture for describing physical examination. Furthermore, entering the diagnosis to the system usually use ICD 10 code, that needs higher knowledge than basic and common diagnostic term, to fill in the blank. If the ICD code does not correct, users are not allowed to skip to another step and maybe cannot finish the EMR.
Also, the laboratory order and medication use the correct name that matches with the database in the system and may need to key 1 time for one order, not one pack of order.
All of the above takes a lot of time for physicians to focus on the EMR not on the patients and may influence the physicians to lose eye contact and human touch for patients during the work.
In my hospital, we have to handle both paper-based and EMR at the same time in OPD. So some doctor will skip EMR and pay more attention to paper-based record as more convenient and they can use acronym as they usually use or vise versa. As it takes a lot of time and decreases the duty-free time the physicians may feel burnout for doing this if they have to be perfect by completely fill in both record.My suggestion to avoid burnout of physician on EMR is
– Use technology to create the input easily such as using the precise stylus to draw and label findings in physical examination or create more drop down menu which is user friendly in the system.
– Diagnosis term in the database should be a combination of medical diagnostic term and ICD 10 and also use the other coding system database.
– Laboratory order should be typed as an individual and a battery of common tests, the list of the tests should be listed by standard of care.
– Medication order should be allowed to type both generic and tradename to find the medication and have a standard dosage and frequency for easily order. In addition, if physicians want to adjust the dosage according to the patient’s condition, it should be done with help in an easy manner. -
2019-11-20 at 8:08 pm #15734Dr.Watcharee ArunsodsaiParticipant
According to a paper by Shaw T, et al. on “What is eHealth (6)?”, there are several definitions that can explain “eHealth”. In your opinion, what should be a definition of eHealth?
From Shaw T, et al.’s study, eHealth is the modern field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. Three domains forming a model of eHealth in this study include:
(1) health in our hands (using eHealth technologies to monitor, track, and inform health)
(2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients)
(3) data enabling health (collecting, managing, and using health data sources)For a definition of “eHealth” in my opinion, I think that it integrated the various tools of information technology to enhance the delivery of health (not just self-health care) to public health and business, referring to health services and information. In a broader sense, this term could enable not only a technical development, but also a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and globally by using information and communication technology.
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2019-11-20 at 4:57 pm #15729Dr.Watcharee ArunsodsaiParticipant
1. Can you give an example of data that you think it could be considered as “Big Data”?
Example of Big Data that I could consider in real life is Big Data of Banking sectors and social media. But if we are talking about Public Health Informatics, in which Big Data could be Electronic Health Records.
2. What are the characteristics of the data that fit into 5Vs, or 7Vs, or 10Vs of Big data characteristics?
2.1 Volume: The data volume of Banking sectors is too large to be analyzed with traditional methods.
2.2 Velocity: The data collected in timely manner and a rapid pace like streams in Banking application.
2.3 Variety: many data types and come from many sources including structured and unstructured such as text and sensor data such as bar code or QR code.
2.4 Veracity: The reliability of the data source is trustworthy, authenticity and accountability, its context, and how meaningful it is to the analysis based on it.
2.5 Value: characterizing by the important of the data can bring to the intended process, activity, predictive analysis for the disease emerging in EHR.
2.6 Variability: The homogenization of the data even the same type, the dynamic, evolving, spatiotemporal data, time series, seasonal, and any other type of non-static behavior in data sources as we can see in EHR. Variability is different from variety. A coffee shop may offer 6 different blends of coffee, but if you get the same blend every day and it tastes different every day, that is variability. The same is true of data, if the meaning is constantly changing it can have a huge impact on your data homogenization.
2.7 Visualization: how critical it is to visualize the large amount of complex data.
2.8 Validity: How accurate and correct the data is understandably for analysis.
2.9 Volatility: How old does your data need to be before it is considered irrelevant, historic, or not useful any longer? How long does data need to be kept for?
2.10 Vulnerability: How secure the Big Data need to be concerned is like in all Banking sectors, social media and EHRs.Some other Vs
Viability: Data activeness and its robustness
Viscosity or Vocabulary: Data complexity, schema, data models, semantics, ontologies, taxonomies, and other content- and context-based metadata that describe the data’s structure, syntax, content, and provenance.
Venue: distributed, heterogeneous data from multiple platforms, from different owners’ systems, with different access and formatting requirements, private vs. public cloud.
Vagueness: confusion over the meaning of big data. Is it something that we’ve always had? What’s new about it? What are the tools? Which tools should I use? -
2019-11-16 at 8:23 pm #15609Dr.Watcharee ArunsodsaiParticipant
1. Have you ever observed a health informatics project in your (other) organization? Please provide a brief introduction.
I have ever used the GIS.BIOPHICS.org for malaria surveillance report for my research work. The GIS map will report the malaria positive cases passively after the patient visited the malaria clinic or the hospitals. The data will be classified as sex, age, nationality, and map of the case distribution by area and time.2. Do you think that this health informatics project can help to improve the current practices, how?
This project can help to inform the current situation of malaria cases and set countermeasure appropriately in time. Thailand envisions the elimination of malaria by 2024 and sets out to target malaria elimination in more than 95% of districts by 2021, and all districts will be malaria-free by 2024.
This health informatics project is setting real time and can alert the awareness of the clinical practice.3. Are there any challenges or difficulty in implementing the project?
The project is disrupted as I could not access it anymore. The challenges may be the infrastructure problems, funds, passive surveillance taking some time to report. -
2019-11-16 at 7:36 pm #15608Dr.Watcharee ArunsodsaiParticipant
Software misconfiguration should be tested for the security setting before release. The databases all ship with default accounts, and when you install applications on your database, they install default accounts, too. All those default accounts have default passwords, and all those default passwords are easy to find on the Internet. So if you leave them in place, it’s kind of like you’re leaving a window open into the database. The authenthication can be misconfigured so all users can access without right. Lastly, the system security should be authorized only few staff to gain access and need regular update configuration frequently.
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2019-11-16 at 7:35 pm #15607Dr.Watcharee ArunsodsaiParticipant
Software should be tested for the security setting before release. The databases all ship with default accounts, and when you install applications on your database, they install default accounts, too. All those default accounts have default passwords, and all those default passwords are easy to find on the Internet. So if you leave them in place, it’s kind of like you’re leaving a window open into the database. The authenthication can be misconfigured so all users can access without right. Lastly, the system security should be authorized only few staff to gain access and need regular update configuration frequently.
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2019-11-16 at 7:21 pm #15606Dr.Watcharee ArunsodsaiParticipant
Singapore’s story is about the hackers’ access to personal information in the health records in government SingHealth.
The method to protect this data breach attack by the hackers may include
1. Traing the staff to use strong, secure passwords, use a complex and unique password for each of their online accounts.
2. Setting the alerting system in the SingHealth for abnormal activities in electronic communication.
3. Act as soon as possible. If the SingHealth see suspicious activity, contact the financial institution involved immediately. If the patient health information including personally identifiable data was stolen in a data breach, let them know that, as well.
4. SingHealth has temporarily banned the staff to access the internet to prevent this phishing via email and cyber-attack.
5. Implement high-quality security software. Install and use a software suite that includes malware and virus protection and always keep it updated.
6. Back up the patients’ files and ensure their safety.
7. Avoid oversharing on social media. Never post anything pertaining to sensitive information, and adjust the settings to make the profiles private. -
2019-11-06 at 8:36 pm #15446Dr.Watcharee ArunsodsaiParticipant
1. Why would you choose cloud server, rather than physical server?
1.1 Increased Security and privacy
Cloud server provides advanced, high-level security features, routine backups and privacy of the patients’ data, providing greater data security than that of an physical server. Cloud server can be easier for upgrading and maintenance.
1.2 Centralized Collaboration
Communication with colleagues and patients is accelerated, efficient, and effective. Everyone uses the same files in the same format in the same place, in real-time, improving the hospital services.
1.3 Mobility
The patrients can access their accounts anywhere, anytime. Patients’ appointment can be made on multiple devices and in any location with an internet connection.
1.4 Scalability
The hospital can scale up or down the workload size to meet the needs.
1.5 Save Time, Save Cost
Cloud server doesn’t require time-consuming software installation and we will no longer be spending money and manpower on IT infrastructure and maintenance. Therefore even we have only one IT staff.2. What kind of cloud computing service model would be most appropriate (SaaS, PaaS, IaaS)? Why?
SaaS, with its pay per-use business model will be the most attractive economic option especially for small hospital, since the need for full-time IT personnel is eliminated along with the main expenses associated with system hardware, middleware, storage, operating systems and software licenses. PaaS is a viable option for larger healthcare institutions that have the resources to develop their own cloud based solutions. PaaS needs more IT satff to manage application and data. Therefore this hospital have only one IT staff available and PaaS is not feasible and may need more cost to handle. -
2019-10-14 at 11:29 pm #14821Dr.Watcharee ArunsodsaiParticipant
If we would like to design an enterprise architecture of health information system among different hospitals within my province, the persons who should involve in the designing process are as following:
1. The provincial health officers as the authority leaders who will gather all stake holders for the meeting and designing EA. This level require responsiveness to legislative, regulatory, and policy tertiary.
2. The specific public health programmer who will take part in designing for particular stable information such as some emerging warning systems.
3. The health care providers at the different levels (community, primary, secondary and tertiary hospitals including clinician consultant) who will design at different context of operational information related to clinical information.
4. Technical or software support staff who will maintain and support the EHR systems
5. Health information management and exchange specialist who can support to ensure the quality and integrity of medical data and interoperability of data.
6. Health information privacy and security specialist who can play role to maintain the privacy and confidentiality of information interface.
7. Programmers and software engineer who will manage, evaluate, educate, perform further research and development of the HIS. -
2019-10-14 at 10:35 pm #14819Dr.Watcharee ArunsodsaiParticipant
An enterprise architecture is needed to be planned by the decision- maker level, all stake holders and builders. These require a large sum of budget and time consuming. In public health hospitals, there are already implemented health information systems which can be sharing to the ministry while can not be linked to each other. It seemed to be one-way communication and redundancy of data because lack of interoperability. As the medical practitioner, we are only the operational level whom will be burnout by the data entry workload but we still need the patient medical records sharing from the other hospitals. We need EA to help not only our practice (available underlying health and diseases) but also governmental health system (utilizing of universal coverage and civil servant medical benefit scheme). Individual hospitals may care about their own information systems and may not feel confident with the others. The other obstacles are the patients themselves whom seek not just only duplicate services in private and public hospitals but also self treatment by over counter medicines. This might not be included in the reliable health informations. So the EA is needed to be set up by carefully balancing of business view and information technology view and served the patient’s privacy and appropriate defined stakeholders. We don’t have HITECH Act but we have only Patient Protection and Affordable Care Act. Then we must ensure the confidentiality of the health information about individuals is not compromised while we plan for the EA.
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2019-10-14 at 5:48 pm #14817Dr.Watcharee ArunsodsaiParticipant
According to my medical and research background, I would need to gain more knowledge on application of informative science and technology in order to improve my project management. Better handling larger scale data will improve my level of capacity to prevent the diseases to national or even global level. I would like to focus on different tools and generate more reliable and comprehensive information for health decision-makers to fight the under five childhood mortalities and morbidities.
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2019-10-02 at 5:14 pm #14269Dr.Watcharee ArunsodsaiParticipant
Hello:
This’s my first vedio to introduce myself.
Nice to see you all,
Watcharee Arunsodsai
- This reply was modified 4 years, 7 months ago by Dr.Watcharee Arunsodsai.
- This reply was modified 4 years, 7 months ago by admin.
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2019-11-24 at 11:48 am #15843Dr.Watcharee ArunsodsaiParticipant
In my hospital, we have a hospital information system (HIS) that can alert like a pop-up in the work flow in prescription and alert or reminder in laboratory results. As an example of Oseltamivir for pediatrician, it will show the pop-up for dosage for body weight, and other example for drug-drug interaction, over prescription for some drugs but not for drug allergy or adverse event or precaution like pregnancy yet.
- This reply was modified 4 years, 5 months ago by Dr.Watcharee Arunsodsai.
- This reply was modified 4 years, 5 months ago by Dr.Watcharee Arunsodsai.
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2019-10-15 at 8:27 pm #14826Dr.Watcharee ArunsodsaiParticipant
Hi Pyae: Your job as a Program Officer of OpenMRS at the national program is impressive and I think that your operational knowledge is even more robust after you finish this course.
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