United Nations Public Service Awards Case Studies

The old Forensic Medicine System (FMS) used to support the operations of the Mortuary at HSA. The application was a Case Registration System with an interface with the Finance system for purposes of invoicing clients. This system attempted to create an integrated workflow for FMD but data by the various processes could not be captured in real time and had to be captured manually. Also, due to limited and older IT technologies prevalent then, data capturing at source was not possible. With the data capture at the PC terminals being so manual, integrated workflow for FMS was difficult to achieve and manage. Over time, data integrity and accuracy issues affected reports printed from FMS and interfacing finance files with Finance. Reports and Finance Interface files were problematic needing constant manual verification of data.

The limitations in the FMS spawned a need for an integrated system that would cover the needs of the mortuary, the histo-pathology lab and Finance; wherein data would be captured just once at source and be re-used for all subsequent functions and processes; and where the bodies and other physical lab samples could be uniquely and accurately tracked so that loss (in the case of samples) or mis-placement (wrong body mistakenly shown to the next of kin) is eliminated.

What is the initiative about? (the solution)
FIONA has positively impacted FMD operations as follows: a) An integrated Case Management System based on customization of a commercial-off-the-shelf software (COTS) package has improved the accuracy and timeliness of data capture. The COTS based solution has ensured that best practices in the area of Forensic Medicine are already embodied in the software. b) Information quality has been improved by capturing data accurately at source once, in real time and re-using it in downstream processes. Best practices from the logistics and inventory sector were found to be applicable to the Mortuary operations and applied. Technologies implemented were: • Information Kiosks sited at right locations have improved police pre-registration process and dispatching of Post Mortem reports. As the Mortuary staff only verify the data entered by the Hearse Police Officers through these kiosks, turnaround of registration at counter has improved by 30% after implementation of FIONA. • Track and Trace technologies applied to Body and Specimen Management work processes have improved accountability where Chain of Custody (COC) is concerned. COC is an essential requirement of FMD as it provides support to Singapore Police Force in crime scene investigations. RFID readers are placed at exit points in Mortuary to detect unauthorised body movement and alert security personnel in such an event. • Document Management module to check in and out the receivables such as case notes, medicines, X-rays, etc. from police/ hospitals has improved the accountability of these items. Previously, accounting for these items was inaccurate as they were recorded via manual book. • Wireless (WIFI) networks combined with Tablet PCs have provided pathologists, morticians and Laboratory officers the ability to capture essential data in real time while working on the move. Counter staff can now access information real time pertaining to autopsy status and claiming process of deceased. This helps to improved customer services at the counter. • Ruggedised PDA for Specimen Dispatch has, with prompt and accurate information update, improved the COC between Mortuary and the laboratories as well as the specimen management process. c) Interlocking work processes are built into the system thereby preventing manual by-passes. For example, the body cannot be claimed until relevant information are verified. Also, staff will not be able to dispatch unapproved Post Mortem reports until they are approved via FIONA. d) With quality information input into FIONA, management reports are now accurate and timely. e) From a healthcare perspective, FIONA has provided improvements in two areas: • Use of electronic body charting on Tablet PC’s in the autopsy suite allows pathologists to refer to electronic copy instead of a hardcopy, while creating Post-Mortem reports in FMD office. From a disease control perspective, it will help prevent spread of diseases as seen during the SARS outbreak in 2003. • Use of ICD 10 (International Classification of Diseases) to codify the Cause of Death and ICECI (International Classification of External Causes of Injury) to codify the Circumstance of Death will in future assist the analysis of these healthcare related data.

Who proposed the solution, who implemented it and who were the stakeholders?
The FIONA was the Dr Paul Chui’s brainchild who is the current Group Director for the Applied Sciences Group within HSA. Dr Chui being a practising forensic consultant proposed a high level business solution as an alternative to solve some of the problems faced in using the FMS. Dr Chui looked beyond the healthcare sector such as using logistics best practices to solve very similar logistics issues faced in the mortuary workflow. Dr Chui had a great sense of appreciation for IT technical details. For example, he saw the usefulness of RFID technologies to be used in the mortuary while he was also quick to point out the difficulties of implementing such technologies. This led to implementing a prototype of the RFID solution in the mortuary to understand the possible implementation issues to be faced which contributed to the eventual successful implementation of RFID in an environment that was considered technically challenging. Dr Chui’s high level business plan gave concrete directions to the line managers and Forensic Consultants who further refined FIONA into a workable operational system. The Administrative and Operational Managers, being familiar with current work processes, redefined the new system workflow by working closely with morticians, technical support officers, administrative staff and Forensic Consultants. This involvement with staff at the initial phase of project overcame some initial fear among staff and also provided a sense of staff ownership for their respective roles in the system. To move FIONA from concept to actual implementation, HSA engaged IT Consultants on the IT planning and execution. Detailed requirements were gathered by IT consultants with help of the FMD Line Managers. A proposed system was finally conceptualised after four months of study. As an outsourced project, an open Tender was called by end of 2006 based on the Tender Specifications of the proposed system. The Tender Specifications provided a framework for IT system and infrastructure implementation. Being an open tender, cost of implementation and maintenance was considered to be “value for money”. The development of the FIONA system was outsourced to an external IT System Integrator who engaged other partners for best-of-breed products and solutions. The FIONA project was managed by with the HSA Project Working Committee Team comprising IT Consultants, Doctors, Pathologists, morticians and other key staff from FMD. This Team provided detailed requirements, reviewed design of proposed system and finally performed the User Acceptance Testing. The Stakeholders were staff from FMD and sponsor was Dr Paul Chui. With widespread use of IT within the Singapore Government, FIONA is well poised to provide accurate and timely information to external stakeholders like the Police, Coroner and the Courts within an electronic framework.

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The FIONA was one of the projects identified under the Ministry of Health’s IT Master Plan for Financial Year (FY) 2005 to 2008 to assist HSA fulfills its long term vision and goals. The FIONA’s objectives were to establish an integrated forensic system to support an automated workflow that would streamline operations, improve efficiency and assure better service to HSA customers besides generate savings in manpower. The Master Plan positioned the FIONA as a strategic project that would improve long term performance of FMD. As required as part of submission, paper also articulated the desired outcome targets based on the new system. The Master Plan was approved by Top Management of MOH on September 2005.

b. What were the key development and implementation steps and the chronology? No more than 500 words
The following are key project milestones that were implemented in the chronological order: In September 2005, the approval of MOH IT Masterplan and funds were made available for FIONA implementation. In June 2006, IT Consultants together with FMD staff initiated FIONA Project. In January 2007 Open Tender was called, in which a number of vendors responded. In June 2007, the tender was awarded after completion of detailed evaluation. In June/July 2008, Project was kicked-off to start the project implementation. In September 2007, the Requirement Specification was signed off. In November 2007, the Design Specification was signed off. Between May to July 2008, User Acceptance Testing was conducted. And finally, on 1 Oct 2008, the system was commissioned for operational use in Mortuary and HistoLab.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
Implementing RFID Technology in the mortuary environment was a technological challenge. It is known that RFID waves are absorbed by water and reflected by metal. In the mortuary, the gurneys and doors of cold compartments for bodies were made of metal and the bodies were containers of liquid (blood) which affected the performance of RFID equipment. A proof of concept tender was called to determine the feasibility of its use in the mortuary before the main tender. This was to mitigate the risk of implementing an immature technology. The supplier of the off-the-shelf software was a foreign company where its consultants are mainly foreigners. At the project’s early phase, there was a communication barrier between users and them, resulting in misunderstanding of the requirements. We were able to persuade the vendor to setup of a localised team which was to overcome the communication barrier and provide speedy local support over time. The use of a local vendor as the main contractor and system integrator was to mitigate the risk of dealing with a foreign contractor. At the operational level, staff had to learn IT Technologies which were not part of their work processes and there were initial teething problems of learning to use new tools and software. These problems were resolved with extensive training and extended on-site vendor support to guide users on navigating the new system. There was some resistance from the staff who had been used to working in the old environment for several years and who found the new system too advanced to cope. There was strong support from HSA top management which assisted to overcome this initial resistance. Unfamiliarity with the new tools led to some technological glitches with the use of Tablet PC in the wet autopsy suite area. However with more briefings and guidelines on safe usage being provided, the problem was soon overcome.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Funding was provided by MOH under the approved IT Master Plan. To ensure it was within budget, the strategy was to plan big and implement in small steps. It was also the responsibility of the IT Consultant to ensure that the project was implemented within time schedule and budget. The project was outsourced to an external local vendor who was monitored for performance in accordance with the tender specifications. From the users’ side, a Project Working Committee (PWC) team comprising IT Project Manager, relevant technical support team members as and when required and key FMD operational staff was mobilised to assist on the project implementation. Getting the composition of the PWC right was a crucial factor to ensure successful implementation. A project plan was drafted to articulate and communicate the roles and responsibilities of this team before it was established. This team was responsible for establishing detailed user requirement specifications and performing User Acceptance Testing with the vendor. As these responsibilities were added on to their daily duties, many of these staff had to stretch beyond their own working time in order to ensure that project was completed on time. Management involvement and support played a significant role in getting user cooperation. A Project Steering Committee team comprising the project sponsor (Dr Chui) was also formed to resolve issues that PWC could not solve and more importantly to garner support for change management when required. The Project Working Committee team besides performing routine project tasks also had to spend a lot of time negotiating with vendors on the project matters. The support and backing of the Project Steering Committee helped to negotiate better terms for HSA.

Is the initiative sustainable and transferable?
The FIONA is very much a part of FMD work process now and FMD depends on this system to achieve work efficiency and effectiveness. In terms of intangible benefits, FIONA ensures data accuracy and reduces duplication of effort. The electronic body charting of autopsy helps to control the spread of diseases. Sustainability of FIONA for FMD comes in the form of financial, environmental as well as operational benefits. The sustainability model for FIONA can be extended beyond HSA. The FIONA has implemented a value chain within FMD that can be extended to the Police as well as the Judiciary which are part of this chain. The police can uniquely identify bodies with RFID tags and create electronic NP 303 (form used by the police to register a body) at site which will streamline registration process at FMD further. At the end of the value chain, the Courts may consider accepting authorised, electronic Post-Mortem reports from FMD which will improve turnaround times of these reports. The extension of this digital value chain to Police and Judiciary will reap operational benefits several-fold for Singapore as a whole. Electronic interaction amongst collaborating government agencies like HSA, the Police Force and the Courts would reduce delays and increase efficiency. With the Singapore Police and the Singapore Judiciary aggressively embracing Info-Comm Technology, such e-interaction is eminently feasible in the near term. Once this model is tested within Singapore this project can be shared and used at the International level.

What are the impact of your initiative and the lessons learned?
Engaging the top management and obtaining its strong support was a key to overcoming operational change resistance. It helped to have long term gains in mind while tackling the day to day operational issues. Getting users involved in the early phase of project initiation (e.g. in creating the user requirements for the tender) helped creating a great sense of user ownership of the system and ensuring less painful implementation. Looking at the best practices in other industries (e.g. Logistics) and considering their applicability to HSA Mortuary operations led to the use of RFID technology to track bodies and specimens. It led to the implementation of a robust COC and a streamlined workflow. With the new system, HSA discovered new ways of improving customer service and public service at the mortuary counter. With accurate and real time information, HSA can use new methods to communicate with its customers. Counter Staff can update, via SMS on mobile phone, the Next Of Kin (NOK) of the deceased on the status of autopsy while they are waiting to collect the body for burial and finally update them on the actual body collection time. Running the mortuary, we cannot hope to give our customers a ‘pleasant’ experience in dealing with us; we aim, with FIONA and other similar projects, to provide them a quick and hassle-free encounter in their hour of grief.


Institution Name:		Health Sciences Authority, Forensic Medicine Division
Institution Type:		Government Department
Contact Person:		Aik Siong Cheok
Title:		Project Manager, IM
Telephone/ Fax:		62138906
Institution's / Project's Website:		62130749
E-mail:		cheok_aik_siong@hsa.gov.sg
Address:		11 Outram Road
Postal Code:		169078
City:		Singapore
State/Province:
Country:		Singapore

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information