 Rydw i'n meddwl gynllun i ddim yn eich panel, ac mae'n ddim cael gwych ar gyhoeddfa arall yma. Fy wnaeth awkward. Rydw i hynny. Mae'r gweithio'r gweithio? Mae'r gweithio, yn rhan. I wnaeth agon i ddweud yn fysylltu gyd yn llawdio'r gweithio'r gweithio'r gweithio wedi fynd. Rwyf i angen i ddim yn unrhyw iawn, a'i gweithio, mae'n meddwl y gallwn ar gweithio'r gweithio'r gweithio'r gweithio. a dweud i wneud yn gallu gwahanol, felly mae'n ddweud yn fwyaf. Ond mae'n ddweud i'r aeth, rydw i'r ddweud i gwych ar ymddangos. Felly mae'n ddweud yma yn ymddangos. Yn ddweud yn gwneud yma ymddangos, mae'n fwyaf hwnnw, mae'n ddweud i'r ddweud, mae'n ddweud i'r ddweud y prôl o'r ffordd, fel mae'n ddweud i ymddangos. Mae'n ddweud i gyd o'r ddweud i'r ddweud. Ond Baunur is y platform where developer and the data is in the hours our exports are anonymised. And we don't use the cloud, so other organisations do use the cloud to allow data entry at remote sites whereas we don't, we do data entry at a central site. But that's something that we want to work on developers to be able to enter data to different sites and synchronise that data because that is the need. Good. Okay. Question then the lady in the pink jumper. Hello, it's Marseff from MSF. It's a question for Mojima. Does this tool allow nurses to plan activities? I mean, can they plan interventions or just is it a data collection tool? Hau'r條dd y gyd-ddyliad am unrhyw holl. Woddwch chi'n gwlad hwnnw i chi'n gweld ffordd mawr o'r twyllog fel hwnnw, oedd iddyn nhw'n cyfrant cyzasio i'r ffordd mawr o'r diogel? O hynny yw hwnnw'n cyfrannwch fyfl ni'n gweithio i wrth gael gwyll yn y ddylliannog o'r ffordd mawr o'r twyllwch hefyd, oherwydd gen i'r twyllwch yn cyfrannwch. data collection tool. Can I make rosters for the nurses or decide when they're going to do stuff? Interventions like health interventions or say I want to plan that a patient is going to have a dressing or they need twice daily dressings and so on. Yes, for the release that's upcoming in the beginning of June they'll be able to first record exactly what intervention they performed on the patient and then plan for the next intervention. So this is still in the planning processes but it's not at this point it's not functioning simply as a data entry or data collection tool. It's really to support the clinicians and provide them feedback on how they're managing the cases. Good. The lady in the black jumper. Hello, thank you. Maria Jose Sagrado from MSF Spain. Thank you very much for the amazing panel to all the presenters. I have a question regarding the EMR. We are talking and we are hearing about EMRs and implementation in the whole movement. So I want to know what is your opinion of full implementations of EMR in the different context that we have and what is the cost of the implementation of this EMR that you have. This wonderful setting in Jordan and what is your opinion in terms of expand these EMRs in the different hospitals that we are carrying out. So in terms of maybe translating the lessons learned you can see that there are similar lessons between the NTB and the AMAN implementation. But for AMAN it's really a specific hospital. We're not a simple OPD-IPD project so the patients are staying a long time. The implementation is quite extended at this point so I can't give you conclusions on what will happen at the end of the implementation. Right now we are receiving very positive feedback from the clinical staff and surprisingly for the initial assessments we've moved to a point of care data entry which is normally very difficult to do in certain situations. So in terms of costs for the cost of the project is not completely owned by AMAN hospital as most of these features were taking the responsibility of developing can be transferred to other implementations. For example the OT list even in a unique setting most of the time and OT list is generated in a similar fashion same with doing OPD scheduling and so on. So if you want more information on the costs you can talk with the eHealth unit. Difficult one it's like measuring a length of a piece of string isn't it the cost of these projects for the sustainability as well as the adoption. There's some more questions here. One at the front here Pete was it? It might be a bit of a strange question. So I was told at an innovation and health conference that I would have nanobots in my blood that would communicate with my virtual physician in my laptop which would refer me to my doctor's hospital. I know you're not doing that but you are. Moving clinical decisions may be away from clinicians and one of the big discussions was about refocusing managing a change in focus from clinicians to technicians. And I wondered if that was a conversation that had been started in MSS Switzerland. Thank you for this question. I think this is something that often comes like is it now the tablet that is treating the patient and this is even a question that was raised in the field. Like someone told us that the community was thinking that there was a magic system that was now treating the patient and this is something very frightening for us. And this is something that's actually when you actually work in this project to realize that you still need and I would not say a doctor because we don't have doctors. And that's why we are here and what we discuss about are we doing a bandage. Of course it would be great to have medical doctors everywhere and we are just trying to help these people that have no training that have limited support to get a better decision. But still they need this clinical knowledge because we are just helping them to decide when they should look for side symptoms but they are the one assessing it. And so it is not working in itself. And again we pay attention when designing the tool so that it helps them to understand the steps they are taking. We do not ask them to answer questions only and then we crush the treatment or diagnosis. We drive them through a process and we have put a lot of efforts to keep the paper format which is not easy to make it look nice or being understandable. But it's a huge for us objective that we have the support to explain them where we are. So that's how it just turned this into more training tool than a tool that is treating the patient. But this like the perception of the community is something that now we are working on and we want to understand better how they received it. And maybe how we can improve the communication we have with them to remind them that it is not a tablet. It is the clinician and the mother or the caregiver who are treating the patient. Excellent. Good answer that question. Alexandra MSF Denmark. Can I ask you if newborns were included in your algorithm and also do you know the explanation for why the consumption of antibiotics was less? Was it due to more correct dosage calculation or was it less children being treated? And if so do you know if the consumption of other drugs went up while antibiotics went down? And then just I'm very and I guess that the prescription for less children had antibiotics prescribed. And I'm very impressed that both caretakers and staff embraced it because being a clinician in an outpatient clinic in Denmark can be difficult to explain why not everybody needs antibiotics after two minutes of fever. So I tried to answer the three questions. I think there were three questions. So for the currently we have a tool that covers the patient from two months to five years. So we haven't yet designed the one from the neonates. This is a plan that I mean what we saw in Barbarati is that the clinician were so happy to use the tool that they began to use it for the under two months, which is worrying for us because then they do not do what they should be doing for this children. One of the first step for us like if we want to extend the scope is to cover this age group. And there is a work currently ongoing with WHO UNICEF and MSF trying to better state what this patient should be, I mean how she should be considered and treated. So this we will try to address. With regard to the drugs, I'm not sure I have understood your question. The data I showed is the proportion of the consultation where an antibiotic were prescribed. So it is not a volume of antibiotic consumption. It's really the proportion of the consultation where the children received prescription of antibiotics. And then yes, I mean as you I am really surprised of the data we have now. How do the clinician really impressed that they follow this. So what we still need to understand as an imitation of this work is that what we have now is the data that they report. What is reassuring for me is that they report the same in the application and in the consultation register. But this is also something that we are trying now to go a bit further and assess further is that is it really the truth that they are doing. And we are trying also to we were trying to cross the information also from the antibiotic consumption data we have from the order they make to the pharmacy. But it's a bit difficult to analyse that because somehow the data we have for the consultation it's not the same calendar than the data for the pharmacy. So we cannot cross it. And also when you look at the data for 2016 the variation in the reported real consumption. It's not about order that they made that they would make differently. Every month the tick and then they count what they had tick in the delivery room and they give us what was the real consumption. And when you look at antibiotic it's just like that. So now we have only few data for the recent implementation of the tool and we see that it's like that and that we are a bit like that. But it can be overlapping so we can't tell whether it had an impact in the real consumption. That's why I didn't show that here today. But no it's part of the work that the anthropologist is doing now is trying to understand the perception also with regard to this new guidelines with regard to antibiotic prescription. Yes questions of truth and data. There are long standing challenges in health informatics and we heard about some of them this morning with a mapping didn't we? A question from the lady in the purple jumper. Hi my name is Alice I'm working in the NHS at the moment. As you probably heard we've been caught up with this sort of cyber attack thing recently. And I just wondered with all the new innovations that are much more computer based. Is there any concern about that sort of thing happening and messing up all of the great work that's been put in in patient care and so on? Good question. Who would like to answer? I'm not the right person to tackle that one. Don't you have to reconnect to the internet to be attacked by cyber attack? Oh that's a good point. Anyone like to tackle that? I mean it's a challenge I think for everyone and it's a global threat and the solutions are. We don't really know what they are do you agree? There's an expert in the audience. Oh there's an expert in the audience. Would you like to volunteer and answer? Eric? Excellent thank you, nothing like audience participation. I'm familiar with the architecture of OpenMRS. You actually don't even need to be close to connect to the internet to get hacked. Any pen drive, any disk, anything you touch, any laptop that goes on your network. So I mean I think as you're rolling this out just do a review of the architecture. Also having your own servers you know that helps but I wouldn't want to alarm people. I would say that you know have a good defense posture and we can help with that together. Yeah just to mention I mean this is something that I mean we know that we want to more and more make use of the data we collect because we I mean still we well defining the purpose where we use the data and but we do perceive that if we were able to collect more data we would be able to design better decision support tools and understand better what is the quality of care that we actually give and what is the outcome and that's what we want to do like designing decision support that would help improve the outcome of the patient so that's key problem and we know that in this world I mean we need to make sure we have appropriate data protection measures from the initial design of our project to then everything that is around that. We go carefully on that topic because we know that there is a lot of ethical and risk that we could take into that but we need to find ways to appropriately and safely go in that direction I think. Well we're out of time sadly but we'll maybe pick your brains about that later Eric thank you. Big challenges that are not just technical of course human and these systems and I'm talking system as in MSF and other health systems are full of people and the people are really where the trust and the dependability lies. So that was an excellent we'll have to wrap up there but thank you very much to all the speakers for some great projects.