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We routinely perform incremental backups of health data stored in the system, managed by the organizational Health Information System team. These backups are securely stored on a cloud server. Additionally, we leverage virtualization technologies like VMware to reduce the burden on physical hardware systems. My recommendation here is that every organization regardless of size or resource availability should develop a comprehensive risk mitigation or disaster recovery plan. A concrete plan serves as a guiding document to assign responsibilities, streamline system recovery procedures, and ensure minimal downtime, data loss, and operational disruption. By tailoring the disaster recovery plan to an organization’s specific requirements and constraints, its effectiveness can be significantly enhanced.
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1) Benefits for Patients
Patients will have access to their healthcare data, lab results, and treatment protocols which will increase their satisfaction. Patient waiting times will also be reduced as their baseline information is already available in the system. Additionally, patients will experience improved safety in treatment services by minimizing treatment errors from healthcare providers.
2) Benefits for the Hospital
Hospital administration and operational services will become more efficient by reducing system downtime and ensuring that data is available for every department. This will also help reduce the workload for healthcare staff. Last but not the least is a reliable system will enhance the hospital’s reputation especially in the private sector -
I have never encountered a data breach of this kind in the health systems I have worked with. However, I would like to share my experience in providing technical assistance to establish data protection policies for a local organization. These policies adhere to the principles of CIA, which serve as the foundational framework for data protection.
Confidentiality: Personal identifiers are encrypted, de-identified, and not shared beyond designated personnel. This includes, but is not limited to, data generated from health information systems, patient records, surveillance activities, quality control efforts, surveys, research, and human biological materials from patients and research participants.
Integrity: User access is controlled through a tiered system with different levels of user privileges, secured by login credentials.
Availability: The local health system employs web-based Health Information Systems (HIS), ensuring data availability online 24/7. Additionally, the HIS team provides round-the-clock support to minimize downtime in the event of any incidents. -
One area of my listening skills that I would like to improve is to give full attention during conversations especially when I am managing multiple tasks. Sometime I am listening in silent mode but my brain is running over the other job intentionally. This happened when I am fully occupied with several works.
Why This Is Important: Effective listening is essential for strong collaboration and building trust in working environment. By improving my listening skills, I can enhance my ability to understand others’ perspectives, respond more thoughtfully, and create a more supportive and communicative environment.
Actions to Improve:
1. Practice Active Listening: Make a conscious effort to focus entirely on the speaker, resisting the urge to plan responses or let my mind drift. This can include maintaining eye contact, nodding to show understanding, and asking clarifying questions when necessary.
2. Limit Distractions: In situations where I know I’ll need to listen intently, I will minimize distractions, such as silencing my phone or closing unrelated documents on my computer, to be fully engaged in the conversation.
3. Take Brief Pauses Before Responding: Instead of responding immediately, I will take a brief pause to ensure I have fully absorbed what the other person has said. This small adjustment can help reinforce understanding and make the conversation more productive.
By implementing these actions, I hope to build stronger, more collaborative relationships and become a more effective communicator. -
My strongest component of EQ is Self-Awareness. I have a solid understanding of my own emotions and am aware of how they influence my feelings, behavior, and decision-making.
However, I recognize that my Social Skills need improvement. May be I am an introvert, I feel more comfortable working independently, as it allows me to focus and concentrate without the distractions of a group setting.
Action Plan: I aim to participate more actively in group settings in both professionally and socially to enhance my social skills. I will also work on improving my conversational skills, which will help me engage more confidently with others. Through these steps, I hope to become more adaptable in team-oriented situations and build stronger interpersonal connections.
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I listened and compared speeches from both leader, following are my reflections on the speeches according to CREC.
Credibility: Both leaders demonstrate credibility by referencing experts and government actions. Singapore’s leader refers to previous SARS experience, enhancing confidence, while the U.S. leader emphasizes aggressive actions and government resources.
Respect: Singapore’s leader shows direct concern for citizens’ well-being, mentioning protective actions at a community level. The U.S. leader respects all citizens, addressing specific groups like the elderly.
Empathy: Singapore’s speech acknowledges public fears and reassures unity, with emotional appeals. The U.S. speech empathizes with citizens by acknowledging the gravity and promising resilience, but focuses more on the nation’s capabilities.Clarity: Both leaders use clear language, though Singapore’s speech is more direct in its guidance (e.g., hygiene practices), while the U.S. speech covers a wider range of policies that might be harder to follow immediately.
Transparency: Singapore’s leader is transparent about uncertainties and potential future measures, while the U.S. leader also conveys transparency, emphasizing protective actions without fully discussing future uncertainties.
Consistency: Singapore maintains a calm, focused message, stressing community resilience. The U.S. leader also calls for unity and strength, maintaining a patriotic, assertive tone.
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The current scenario for Myanmar
Technology Infrastructure
Myanmar’s healthcare system has limited digital infrastructure, with technology adoption at varying levels across regions. The implementation of digital tools for health intelligence, data collection, and sharing remains limited, especially in rural areas where healthcare facilities often lack basic digital resources.Techquity
Disparities in digital health access are significant in Myanmar, where a substantial portion of the population has limited internet access, and digital health services are largely unavailable in remote areas.Transparency and Trust
Public trust in digital health systems may be low, particularly when there are concerns over data privacy and security. Myanmar’s digital health systems are still evolving, and public awareness about data privacy rights and the benefits of digital health solutions is limited.Transformation of Healthcare Systems
Myanmar’s healthcare system is still primarily paper-based, making it challenging to integrate digital health solutions effectively. The absence of standardized electronic health records (EHRs) and other digital health tools hinders the efficiency of healthcare delivery and pandemic preparedness. -
Disease Outbreaks Declared as PHEIC
The outbreaks which have been declared as PHEIC by the World Health Organization (WHO) as follow:
• H1N1 Influenza Pandemic (Swine Flu) in 2009
• Polio Resurgence in 2014
• Ebola Outbreak in West Africa in 2014
• Zika Virus Outbreak in 2015
• Ebola Outbreak in the Democratic Republic of Congo in 2018
• COVID-19 Pandemic in 2020
• Monkeypox in 2022Reasons These Outbreaks Raise Concerns
These outbreaks are concerning for several reasons such as high transmission and infectious, lack of immunization, difficulties in control and last, it can have serious impact on the country economic.In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
Since we are tropical countries and especially in countries from GMS regions, my assumption is climate driven disease such as malaria and dengue could spread in the new regions due to climate change. -
Two specific gaps identified in the Korean hepatitis B surveillance system include:
Misreporting of Chronic Hepatitis B Cases: Chronic cases are often inaccurately reported as acute cases due to a lack of clear diagnostic guidelines that differentiate between acute and chronic hepatitis B​.
Underutilization of the Surveillance System: The system’s focus is limited to acute cases, missing opportunities for managing chronic hepatitis B and promoting preventive interventions like vaccination​.
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Digital technology greatly enhances disease surveillance by enabling rapid data collection, analysis, and dissemination. Data analytics, such as desriptive study and predition, can process massive datasets to identify patterns and predict disease spread. Geographic information systems (GIS) can map disease hotspots, providing visual insights into transmission paths. Digital platforms enable fast, coordinated responses by connecting health organizations and government agencies. Cloud-based systems ensure secure, scalable storage for extensive health data. Digital tools also support public health communication, educating communities and helping contain disease transmission. Overall, digital technology strengthens proactive, data-driven responses to public health threats.
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It is depended on different point of view,
From service provider POV: EMR integrated with support of clinical decision making is important
From clients and patients POV: Tele health app or system will help them to improve access to health care
From public health care managers POV: A data visualization tool with Covid 19 epi trend will help them to implement effective and efficient control measures
From data scientist POV: Infectious disease data modelling with geospatial (to map geo site of disease outbreak etc.) and statistical (to learn disease pattern from big data etc.) will help to analyze the existing situation and predit the disease spread. QGIS/ ArcGIS for geomapping and R/python can be used for data modelling. -
1. How can surveillance help to detect and control the disease?
Surveillance can help to detect early the possibility of disease outbreak. Early detection will help to improve prevention and control measures for the infectious disease before outbreak to general communities. It will reduce the burden on health system, reduction in consuming resources and improve health outcomes of general communities.2. Should we conduct active or passive surveillance or both for the disease, why?
Both will play critical role in infectious disease surveillance like mPox. Although active surveillance provides immediate reporting (timeliness) of early detected case in large scale, while controlling the quality of data (completeness and accuracy), it is more resources intensive. Passive surveillance can provide secondary data from multiple sources such as routine HMIS, survey/ assessment etc. It will be cost effective measures but there may be under reporting on the passive surveillance as it relies on the secondary data source3. Which method should be best to identify cases, why?
a) Cases in medical facilities VS community
We need to know the nature and characteristics of disease we want to control to implement different types of surveillance system. In mPox scenario, Facility-based surveillance is more practical for severe cases seeking care, while community-based surveillance captures milder cases, critical in high-transmission diseases
b) Sentinel VS population-based surveillance
Sentinel surveillance, which uses selected sites, can provide detailed data on specific diseases but lacks generalizability.
c) Case-based VS aggregated surveillance
It is context specific to implement the case base or aggregated reporting for disease surveillance. In resources limited setting, aggregated reporting will be useful to implement for intensive outbreaks but it will be lacked of detailed and specified informations to be reported. Case base is resource intensive but useful in detailed information reporting and contact tracing.
d) Syndromic VS laboratory-confirmed surveillance
In mPox case, in health system of resources limited and hard to reach areas, syndromic surveillance allows rapid detection based on clinical signs, useful for immediate alerts but lab investigation will be needed as gold standard for case confirmation4. What dissemination tools will you choose to disseminate monkeypox surveillance information? Why do you choose this/these tools?
Social media, mass media including radio will play critical role in dissemination of information to general community. For health managers and health care stakeholders, Epi Info, health map integrated with GIS, disease trend and epi curve will be useful. Open source data visualization tool like glooker will also be useful for public sector. -
Case base or aggregated data can be provided based on following criteria,
1)Purpose of the study,
a. if the study is just only for cross sectional malaria epidemiology like malaria incident, treatment coverage and outcome, ABER etc. Aggregated data can only be provided.
b. If the study is controlled trails, case based data can be provided without personal identifiers like name, ID, contact, geocoordinate etc.
c. If the study is clinical trials, a strong ethical approval might be needed from local institutions like MORU, NHSO etc. Community consent is mandatory to provide the individual data.2) Ethnical approval
a. Ethical approval will be needed for the study. Case based or aggregated number can be provided based on the criteria above.
b. MOU/ agreement between researchers and data providers will be needed to minimize the mis-use of data -
I have to maintain confidentiality of patient information. But will discuss/ advocate with the patient to disclose the situation with partner as it might become a risk. In private sector, disclosing of that individual patient information without consent will make huge impact by damaging company/ organization reputation and financial loss.
What if we think from another perspective? In cases of contagious and outbreak diseases like COVID-19, we have to inform health authorities about the situation for the sake of doing good in large communities even though individual patients have the right to keep their health information secret.
Conclusion: Maintain individual patient information but advocacy might be needed for not contagious diseases. Disclose information for contagious and outbreak diseases but this should be led by health authorities.
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Let me share the information from the previous scenario which was failed.
Awareness: The organization itself is not aware on the system thinking approach which make vertical promotion of the system. Desire: Each separate team want to focus only on their works and functions. Knowledge: Limited knowledge on the systematization and system thinking within the organization. Organizational change management would help to improve optimization between the sub systems. But organizational leadership involvement in this process is critical. -
I observed one supply chain system application which was utilized by a health care organization. The system was failed due to the design of the system which was focused only on medical commodities and pharmacy management. Logistic system was not integrated into the whole supply chain system which made it difficult for logistics team to manage stock control procedures including stock in, out, distribution and warehouse management. So, Logistic team is trying to use another system which resulted in a lack of interoperability between the systems.
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For Health Service Provision Level
In low-resource settings, there is a lack of a digital clinical decision support system. However, maintaining a longitudinal record of patient information in either a patient booklet or logbook could enhance clinical decision-making, particularly for non-communicable diseases (NCDs).For Health System Level
Implementing a digital disease surveillance dashboard with an automated alert system could significantly enhance decision-making in healthcare implementation. Additionally, dashboards for Human Resource Information Systems (HRIS) and Logistics Management Information Systems (LMIS) could further contribute to improvements in the health system. -
If healthcare facilities do not utilize the ICD standard, there will be a lack of standardization in disease diagnoses. From a health system perspective, this data inconsistency and the absence of standardized case definitions could result in fragmented data aggregation for vital statistics for policy making, outbreak disease surveillance and health system monitoring. Consequently, this may hinder efficient healthcare service delivery due to a lack of evidence.
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What do you think about this finding?
This article presents evidence on the challenges of EHR utilization. However, there appears to be potential researcher bias in the literature review, and the scoping review may lack a critical appraisal. As a result, the study primarily focuses on the negative aspects of various EMR systems. A systematic review could provide a more balanced perspective by highlighting both the positive and negative findings, considering the type, complexity, and design of the EMRs.Have you ever heard any complaints from health officers (or yourself) on using EMR?
A few months ago, I conducted an impact assessment on the use of EMRs in low-resource settings. This qualitative study revealed that a significant proportion of healthcare providers face challenges in utilizing EMRs in primary care setting. These challenges contribute to the burden on the healthcare system and exacerbate the shortage of human resources for health. Key findings from the assessment include the lack of contextual relevance in EMR design, particularly in fragile and conflict settings, limited digital literacy among healthcare providers, system complexity, and the absence of interoperability between systems, such as laboratory, pharmacy, and radiology.Suggestions:
Improving user-friendliness and interoperability will be game changer in enhancing the efficient use of EMRs. Reducing the burden of data entry, especially in low-resource settings, could also be an effective strategy. Additionally, adopting the PDSA (Plan, Do, Study, Act) framework can help continuously monitor EMR utilization for quality improvement and better outcomes in its implementation. -
My own definition of eHealth is a comprehensive digital or electronic healthcare system designed to support health promotion, disease prevention, and health protection. The eHealth system should operate across three layers of the public health system: not only enhancing individual and community health but also assisting healthcare providers in delivering services through digital technologies. Even health insurance/ social security mechanisms should also be integrated in the eHealth system towards UHC. Additionally, it should support public health management by leveraging Big Data generated within the eHealth system to improve decision-making and resource allocation.
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1) Example of big data
If we want to review the big data from V characteristics, let me share the Myanmar Demographic Health Survey 2015-2016 data as big data of Myanmar. Over 13,000 households including 17,000 + individuals were interviewed to capture a wide range of socio demographic characteristics, fertility rate, data for composite coverage index (for UHC? But I am not sure), nutrition, access to health care, 3 disease, and women empowerment.2) MDHS 2015-2016 in 5 V characteristics
Volume
The MDHS was a large-scale data collection for more than 17,000 sample size. The dataset includes data on numerous variables such as health outcomes, family structures, and socioeconomic indicators. This large-scale collection qualifies as Big Data due to the volume of individual records and responses.Velocity
Initially, DHS was planned to conducted periodically and although the data is not real-time, the process has improved with digital data collection tools. Survey responses were collected through tablet which enable faster data processing and more rapid analysis compared to traditional paper-based methods. It reduced the human error as well.Variety
MDHS ollected structured data like demographic statistics, health outcomes) and semi-structured data including qualitative data from individual and household interviews, qualitative survey responses. The variety of data includes numerical metrics, categorical health outcomes, and more subjective answers regarding access to healthcare or family planning services.Veracity
In MDHS, veracity issues might arise due to self-reporting biases (e.g., underreporting of sensitive topics like domestic violence or HIV status)Value
The Myanmar DHS data is highly valuable for health actors including international organizations and UN agencies. It helps inform public health policies, guides resource allocation, and contributes to initiatives like improving maternal and child healthcare, tackling malnutrition, and addressing infectious diseases. Even though it was published last 8 years ago, public health actors are still using it as a baseline information for health program management since no national level health survey can be conducted after this nationwide survey. -
1) Observation of HIS project in the organization and use of the system
I observed 2 levels of HIS applications and project in the local health system of the border areas. The HIS applications are developed based on the 2 level of perspectives, from provider + client perspective and the other one is from heath system perspective. The first one is intended to improve the quality of care, improve clinical decision making and clients access to their health information like EMR. The second one is utilized for health planning, management and disease surveillance as aggregated HIS.
2) Challenges
The two systems are developed based on the different perspectives by different health care unit, information exchange between the two systems are quite difficult due to the different architecture, fields and data elements. This resulted the data cooperation between the system are challenging for health promotion, prevention and management. -
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Awarenees raising on phishing and scamming, training on digital security will help to improve digital security literacy of the employees as you mentioned. In addition to this, regular vulnerability assessement of the system and risk migitaion plan development should also be institutionalized as a prevent measure.
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I will choose cloud server and PaaS based on my current resource, which is just 1 IT staff.
1) Cloud server will work on this work.
Configuration might not take time for cloud servers. Most cloud provider provide service on the instant configuration work.
No need to take time to set up the server, just pay the subscription fees and we can utilize the server instantly.
Intensive resource will not be needed for regular maintenance of the server.
User can access to the cloud sever without needing of additional networking device.
However, from data security perspective, we have to check the reliability of the cloud provider, cloud server hosting place and country etc.2) PaaS, as it simplifies the process of the web application, reduces the need for infrastructure set up in resource limited setting, speed up the process of web application development from both front end and back end by utilizing the existing tools.
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Since there are many digital security threads, I would like to mention some methods that are mostly used by attackers as follows.
1) Phishing
Attacker faked themself as a legitimate one to receive valuable information like bank account information, digital login credentials, and demographic and health information. In recent years, attackers used not only email channels to scam but also several social media channels to steal sensitive information. Most organizations make users awareness on phishing on this day.2) Malware
A computer or digital device will be infected by malicious software to steal the information, encrypted the existed data or control the system. Downloading and installing pirated software causes a significant amount of malware infection in the digital system. The enterprise-level organization set up a firewall to control over the network, install antivirus software, promote to use of the license software, and ban malicious websites for safe surf over the internet.3) Ignorance and lack of digital literacy
Most people use the same login credentials for every account which means one breach will result in losing everything. Login and synchronization of the email in the browser, an auto-fill function is on and if that digital device is stolen for some reason will make a significant breach of digital security. -
I led the development of a disease surveillance system application capable of monitoring, surveillance and reporting disease outbreaks, including COVID-19, vaccine preventable diseases and communicable diseases. This native Android application was integrated as a modular component under the COVID-19 vaccination system and is widely used by various local health actors.
System Limitations:
The application is designed to detect and report disease outbreaks using both event based and indicator based reporting in real time. However, inconsistent internet access across local health organizations has posed challenges, making it difficult for some organizations to report data in a timely manner.Role of Health Informatics:
In version 2, HIS team led by Aye Thinzar Oo modified the application to allow offline data recording and added synchronization functions to upload data to the cloud once internet access is available. Key variables and disease classification standards were aligned with ICD-11 to ensure standardized data usage and facilitate data exchange between local health actors. Backend was refined to accommodate the updated variables and disease classification. -
Leadership and management in public health skills will play pivotable role in establishing a robust Health Information System (HIS) within the local health system. Such a system would not only promote standardization but also facilitate interoperability between various subsystems, including the Human Resource Information System, Pharmacy/Logistics/Supply Chain Management System, and Vaccine Management Information System.
However, it is important to note that building a strong HIS without effectively translating the gathered information into actionable knowledge will limit its efficiency and impact. Therefore, encouraging the utilization of the knowledge derived from the established HIS will significantly enhance disease prevention, health promotion, and surveillance efforts. In that case, knowledge in public health epidemiology is the key to understanding the disease patterns, identifying risk factors, and developing effective strategies for disease prevention and control.
In short, leadership and governance skills in health systems are essential for developing an integrated and interoperable HIS that not only improves data exchange among local health stakeholders but also ensures that this data is used for informed health planning, decision-making, and health system reform based on community needs. -
This is Alex, a medical doctor working as a Director of MEL and Health Systems Strengthening. I hold a master degree in public health and this is my second master degree specialized in health information system development. My areas of interest in this program include health information system architecture, data modeling, machine learning, and disease surveillance systems. It’s a pleasure to meet you all here.
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