Highlights of Some Contemporary Challenges

Bongs lainjo


My latest lecture video to University of West Indies, Kingston Jamaica graduate students titled “Developing Evaluation Protocols” is now available via the following link:




The Ubiquity of Electronic Hacking: My True Cyber Crime Story

The Ubiquity of Electronic Hacking: My True Cybercrime Story

By Bongs Lainjo, Author of “M and E: Data Management Systems”

In the past year alone, large, high-profile companies, including Bell Canada, Deloitte and Equifax were victims of cyber attacks, failing to protect their systems and their customers’ private information. If titans of industry with a small army of people working to protect those systems are vulnerable, what makes us mere mortals still believe it can’t happen to us?

I too used to think that only careless and complacent neophytes were likely to fall victim to electronic crime. Boy, was I wrong. So wrong that I ended up with the leading role in my own true cybercrime story.

As I do every year, I contacted my telephone service provider (SP) in December to suspend my services for a period of time. And as always, I tried to contact the SP electronically via a chat session. The process of logging in to my account to do so became impossible. I tried every username and password combination to no avail. Based on the excessive number of log-in procedures that many of us have to perform for bank accounts, emails, telephones, etc., I concluded that I may have forgotten the log-in parameters. Wrong again.

I begrudgingly contacted my SP by phone, got comfortable, waited for the endless loop of muzak to begin, and proceeded to hold until what felt like the end of time. Someone finally picked up and delivered the dreaded 2 words: «You can’t!»

That’s the immediate response I got from the SP representative for wanting to suspend my services. When I asked why, the SP told me I had a contract plan and holders of such plans are NOT eligible for any service suspension. I smelled a rat and knew the worst was yet to come.

Fast forward one week: My telephone bills have been automated for the last decade. Every month, I receive an electronic statement from the SP. Unbeknownst to me, and partially because I trust my SP, I realized that I had not received my September and October 2017 statements – even though automatic deductions continued to be made from my account.

During my earlier phone call to the SP, I listened to an automated message detailing my payments and deductions for the month of October. The payment amount was more than twice my regular payment. The drama only escalated when I eventually spoke to a real person at the other end of the line. When the SP told me about the ineligibility of suspending my services, I reminded the provider that I wasn’t doing anything out of the ordinary, and that in fact, I did this every year. She reiterated that because I was on a “service” contract, I couldn’t suspend my services. I retorted that I wasn’t on a service contract. The SP insisted – even telling me the brand of phone I had, which was provided as part of the contract. I told the SP that  during the last decade, I had always used my own phone and that contracts were not desirable to me. We agreed that I needed to verify my automatic deductions. Once I did, I found out that monthly overpayments had been deducted from my account more than twice. I also verified my electronic monthly bills, and low and behold, I had not received any bills for September and October. The SP confirmed that the bills were sent to my “new” email address and that was the reason no red flags were raised.

The SP immediately initiated an investigation, and all the extra charges to my account were reversed. It turned out the perpetrator hacked my SP account and modified my details, including changing my email address, to syphon payments from my account to pay for their costly new phone and services.

So what can we take away from this? Even with painstaking care taken by some users and providers, hackers are generally always ahead of the curve. With all the sophisticated and advanced technological strategies available and implemented by some small and large organizations, the challenges continue to evolve with limited green light on the other side of the Rubicon. This situation becomes even more distressing when trusted “insiders” are found to be complicit in some of these criminal practices.

Hacking Trends and Big Data

Users expect a safe and secure online experience, for both business and personal purposes. However, increased data breaches, espionage, and cybercrimes can erode trust. Reports indicate that 178 million records were stolen in 2015, with security breaches highest in Asia and the Pacific region while Europe and North America reported the lowest. In this regard, cloud management is a major and increasingly expensive challenge.

Cybercrime damage is expected to cost the world more than $6 trillion yearly over the next five years – up from $3 billion reported in 2016. Costs include stolen money, destruction of data, loss of productivity, post-attack disruption of normal operations, embezzlement, and theft of intellectual property. The costs also include reputational harm, forensic investigation, and restoration of hacked data.

With cloud-based enterprise workloads projected to increase by 29% in the next five years, security remains one of the biggest challenges. Furthermore, according to current research findings, electronic theft is yet to peak and the tipping point will surely be a wakeup call for all of us!

At a personal level, my experience as a user of many services reminded me how vulnerable we are, especially in circumstances beyond our control. Even when precautions are taken, the reality is that even the most diligent and adept institutions remain at risk. So stay vigilant my friends, and try to make peace with musak and being put on hold.


Please post all queries below in the comments box and they would be answered as soon as possible. Thank you


Title: The Evolution and Dynamics of Electronic Health Record Systems (EHRSs)




The aim of this study is to review the transformation process involved in converting the current manual medical records (MMR) into electronic health record systems (EHRSs). The study also illustrates a life case study conducted by the author as stage one of implementation of the center for Medicare and Medicaid services (CMMS) electronic health record (EHR) incentive program (Cohen et al., 2015). The third objective is to thematically highlight the prevalence, achievements, challenges and prognosis of implementing EHRSs.


The study is focused on global, regional and national geopolitical systems. A group of select industrial countries in North America, Oceanic, East Asia, and Scandinavia is used to illustrate the dynamics and transformation system of medical records from manual to electronic. India is also included.


The methodology that is used analyzes the global, regional and the national implementation rates of the electronic health records systems. The review is made based on the different governments’ role in making sure that the system is a success without compromising the quality of service. Also physicians’ attitudes towards the system were used as part of the review process. A comprehensive analysis of the whole EHRSs ecosystems is performed.


The findings in the study were that the implemented EHRSs are faced with a lot of challenges even if there are some subsequent benefits (Delbanco, 2008; Phillips et al., 2009). The systems are prone to transcribing errors that the user may not understand and address (Phillips et al., 2009). The errors maybe transferred to the patient’s medical results: a process that is likely to compromises the patient’s safety and quality of service. There is also the likelihood that people using the system may not fully embrace it (Davis & Stoots, 2013). According to study findings, while significant efforts have been made by various governments to encourage EHRSs, enormous challenges (standardization, programming glitches, system failures, vulnerability of patient records, confidentiality, other internal and external factors) continue to slow down the process. There is a global absence of instituting an effective and inclusive team to contribute in the design and development of EHRSs. Inadequate oversight has also impacted implementation processes. Denmark remains a trailblazer in efforts to computerize manual medical records.


Innovations come with relative risks. The MMRs are no exception and in this case, the challenges are even more exacerbated by the involvement of different players at the various stages of the transformation process. Potential setbacks range from human errors, to computer system breakdown to uncontrolled external factors and sometimes, internal factors. While caution remains a key mantra, stakeholders (government, doctors, patients, service provider etc.) need to balance the benefits of implementation against risks of failure and the degree of vulnerability. And in general, when such initiatives succeed the rest is history.

According to the research findings, various countries have implementation rates based on the degree of government support and involvement (Davis & Stoots, 2013). For example, in the year two thousand and nine, the U.S had the lowest conversion rates as compared to other industrialized countries. This was due to the lack of government participation including incentives encouraging institutions to participate in converting their respective manual systems into electronic ones. This outlook changed in 2012 when the U.S government became more actively involved: an initiative that has seen an improvement in the conversion rate (Balgorsky, 2014).


In general and as expected, the implementation of an EHRS has made various achievements such as reducing the bulkiness that comes with paper work, the patient’s records cannot be easily misplaced and patient record access has improved significantly. The preceding remarks notwithstanding the likelihood of compromising patient records, though lower remains a major concern (Phillips et al., 2009). A compelling complementary and invaluable safeguard is the introduction of strict quality control guidelines. For example, cases where wrong medications are issued to patients and that have fatal effects. An effective and continuously monitoring framework will go a long way in mitigating patient vulnerability. And in general, given the current evolving dynamics, the benefits significantly outweigh the risks especially in circumstances where all the bugs in the systems have been corrected. While a successful implementation is plausible, stakeholders need to be reminded that provision for operating parallel system (manual and electronic simultaneous) for substantial amount of time remains unavoidable. Adapting such a process will guarantee continuity and sustainability.


(Key Words: EHRSs, Prevalence, Achievements, Prognosis, Challenges, Dynamics, CMMS, Global, Regional, National, and Quality of Service)





Below is an audio link of an M and E plan lecture module I recently gave graduate students at the U. of W. Indies Kingston, Jamaica. And for the technically savvy, I have included the outline:

1. Strategic Framework (Logframe, Results Framework) and its importance;

2. Description of a Monitoring and Evaluation Plan;

3. What an M and E plan is used for;

4. Why M and E plans are required;

5. M and E Plan target;

6. M and E Plan stakeholders and 

7. An outline of how to develop and M and E Plan.


Hope you find it useful and do not hesitate to share your thoughts with me.




How often do you visit a sauna? And do you believe in its benefits?

Several years ago during my stint in Asia and based in Kathmandu – Nepal, I had my first experience in a sauna. Before the first visit, I had previously heard about saunas and how useful they are. Of course here in North America, saunas are not as ubiquitous as they are in Finland. In fact in that part of the world, almost every household has one! This of course makes it difficult for anyone to conduct a randomized control trial. They are just no controls!; even though the participants in one study (more later) were divided into three groups of sauna frequency and duration. On the other hand, here, saunas remain a luxury and can only be generally found in a few places where the utilization rates are relatively low. In Asia for example, saunas are in many cases owned and managed by hotel chains and hence availability becomes quite exclusive and limited.

One major difference that I discovered between saunas in Asia and the ones here is the set up and control processes. Here, where they exist, users all seat in and share one heated room (dry and wet environments). In Asia on the other hand, there is a small cabin assigned to every client.

Over the last several years, I have been a yellow dog believer in saunas. And this believe is so compelling that each time I am unable to go to the sauna, I feel quite vulnerable. And as it turned out, there are quite a few regulars too in the CVE. Some of them also visit this hot room as often as I do. One thing I observed mixing with these groups is that the room serves as both forum for camaraderie and “bad blood”. One of my sauna buddies once remarked that some people come to saunas here to flaunt their previous authority: a carry-over from their CEO days. In summary, I have found the level of openness and warmth from many visitors quite positive.

And the benefits? I’m not quite sure what others think. From my experience, each time I visit a sauna and have a good sweat, I feel calm, relaxed, more energetic and stress-free. This includes long and uninterrupted sleeping periods.

In a study published online by JAMA Internal Medicine conducted in Finland among males (no gender overtones implied), the researchers came up with very interesting findings. Before we look at details of this study there are some caveats that need to be highlighted : participants were all males; it was an observational study (no cause and effect outcomes expected); they were dry saunas; duration of stay ranged from 104 to 212 (average was 174) degrees Fahrenheit or 40 to 100 degrees celsius; duration ranged from two to 90 minutes; those who benefited most were people who spent twenty or more minutes bathing.

Setting and Findings: Between 1984 and 1989, researchers recruited and followed a cohort (open) of 2315 middle-aged (42 to 60 years) men in eastern Finland. The participants were asked to fill weekly questionnaires (self-reporting) about their sauna weekly frequencies.

Most participants (1500) reported visiting the sauna two or three times weekly; six-hundred visiting once a week; with two hundred frequenting the sauna four to seven times weekly. 12 never used the the steam room at all.

According to the study, once-a-week visitors when compared with daily (seven times a week group) were more likely to die from sudden cardiac arrest (SCA), heart disease (HD) and cardiovascular disease (CVD). When both groups of visitors were compared, the study found that in the latter cohort, the risk of dying from SCA, HD and CVD was 63 per cent lower when compared with the former group. Some of the baseline indicators included good pressure, electrocardiogram, cholesterol, C-reactive protein, smoking, alcohol use and frequency of exercise. In its findings, the researchers concluded that frequency and duration of stay were inversely correlated to lower risks of sudden cardiac death, fatal coronary heart disease, and fatal cardiovascular disease over the 20-year period of time.; suggesting that frequent and long sauna durations were beneficial to our hearts. This association remained unchanged even after certain confounding variables were controlled.

According to the study, in 2011, the team retrospectively reviewed hospital documents including death certificates and autopsy reports to assess participant cause of death.

Mortality and cause of death Percentage of Sauna Study Participants in Finland
Source: Study Data


According to available data on all mortality (1807 cases) distribution collected and reported retrospectively, the graph illustrates that the percentages of mortality among sauna cohort participants were 10%, 16%,22% and 52% in the SCA, CD, CVD and other respectively.

Finally, with regard to sudden cardia death the research team reported that ten percent of the once-a-week sauna users died; eight percent of those who used the sauna two or three times weekly and five percent of those who went four to seven times per week also died.

So, is it time to check out our well-maintained and managed sauna in the club house? Your call, check it out!

U. of West Indies M and E Plan Workshop


M and E Plan Pre-Test Answers

CORRECT ANSWERS: 1 B; 2 A; 3 A; 4 A; 5 B; 6 B; 7 A; 8 A; 9 B; 10 A