| 4. In which ways is the initiative creative and innovative?
|
|
The development methodology of PrisMS is based on the traditional software lifecycle, with the addition of prototyping before the system design phase and very detailed system testings to ensure zero errors.
During the planning, the project team met up to finalize on the scope and schedule for the project. The roles and responsibilities were clearly defined and understood by everyone. With that, each team member was able to perform his tasks effectively and minimize delays due to miscommunication in the delegation of tasks.
During the requirement gathering phase, the project team conducted numerous requirement gathering sessions with stakeholders to identify their Specific Operational Requirements (SOR). The stakeholders included representatives from the nursing staff, pharmacists and medical officers, and Prison officers facilitating the medical treatments within Prisons institutions. Together with Medical Service Branch’s requirements, the SORs were cross referenced with each other. The scope of project involved converting the manual processes to a fully electronic workflow. The missing gaps and differences were sorted out during the review sessions, before signing off the first baseline of the requirement specifications. With the requirements, Tech Branch and vendor project teams met up with other IT vendors that PrisMS interface with to discuss and finalise the interface specifications as part of system design phase. These systems were Prison Operation and Rehabilitation System (PORTS), an inmate management system and the Automatic Tablet Machines (ATM).
During the system selection process, the project team emphasized on attributes such as ease of use of the system and fast system response. The system should be intuitive and responsive, as these were pivotal to the users’ acceptance of the system. To mitigate the risk, the team reviewed the prototypes of PrisMS to ensure that the user interface was well-designed and easy to use. Anyone should be able to use the system without training and guidance, with most commonly used functions presented to them and completed within 3-4 clicks.
Implementing a system in Prisons is unlike implementing in a typical office environment. The building infrastructure of clinics and medical centres in the Prison institutions were not suited for electronic operations. Tech Branch project team had to conduct site surveys for over 40 clinics and 3 medical centres in the 3 Prison clusters. For each site, the team identified the locations of additional network points and power points, the number of computers, printers, fax machines and scanners required. With the information, the project team had to convince the Prison management to support the changes, before working with the respective Prison cluster representatives to procure and install the equipment. As Prisons is a secure environment with the inmates’ being incarcerated, at various phases of the project life-cycle, the Prison staff at each site were engaged to facilitate the construction works and deployment of the medical software and equipment (with inmates’ presence). These activities affected Prison operations and brought inconveniences to their daily work routine. However, through careful planning and coordination by the project team, all the works at each phase were completed smoothly and without delay or time wastage.
Being a medical system, having a bug in PrisMS could be life-threatening. For example, wrong drug prescription for an inmate who has severe allergy reactions or wrong diagnosis of an inmate could be result in serious consequences. To ensure the accuracy, the system goes through rigorous rounds of functionality tests and data verifications. In addition, to ensure that all medical personnel were able to operate the system effectively, the project team conducted system proficiency assessments for medical staff about 2 weeks after the training sessions were completed.
|
|
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
|
The close collaboration among stakeholders contributed to the successful implementation of PrisMS . The Project Team comprises staff from the Medical Service Branch (MSB) and Technology Branch (TB) of SPS, vendor from Magicsoft Asia Systems Pte Ltd (MASPL), users from Parkway Shenton Private Limited (PSPL), Institute of Mental Hospital (IMH) and KK Women & Children Hospital (KKWCH).
In 2010, the project team was formed to conduct a requirements gathering exercise, review existing work processes and developed new work processes to support the implementation of the system. The project team reviewed proposed solutions from several separate potential vendors, visited restructured hospitals and polyclinics and attended various talks and conferences on healthcare IT systems. A tender was launched by the team in Oct 2011 and awarded to MASPL on Jan 2012. Weekly meetings were held and subsequently the medical service provider, PSPL came on board to work on the implementation planning, testing and eventual commissioning.
Many hours were spent gathering user requirements, reviewing and streamlining the processes and user training and acceptance testing by MSB and PSPL. Training was also coordinated for other stakeholders such as IMH and KKWCH.
The system was commissioned on 27 Dec 2012. During the months following the launch, the team was deployed to the ground at various locations across all three Clusters troubleshooting issues, providing support, solutions and generally hand-holding the PSPL staff often late into the night. To date, the system has been running smoothly and that it has achieved what it set out to do.
|
| 6. How was the strategy implemented and what resources were mobilized?
|
|
PrisMS was funded by the Singapore Government. The project cost approximately SGD 1 million. The cost did not include the manpower provided by Prisons to support the project, and the infrastructure cost to equip each medical centre with the computing devices.
Besides the project team who was fully committed to the entire project life-cycle, there was involvement from many different branches and divisions of SPS at various phases of the project to ensure the smooth and successful rollout of PrisMS.
During the requirement gathering phase, nursing staff and doctors from the medical service provider were involved. All medical staff also attended PrisMS trainings and proficiency assessment sessions before the rollout of PrisMS.
Key stakeholders of Prisons were involved in providing SOR to PrisMS to ensure that PrisMS is able meets their operational needs. The respective logistics and IT branches at each cluster were also involved in setting up the required equipments in each medical clinic, to ensure that each clinic can operate efficiently when PrisMS goes live.
Unlike a normal office, Prisons is a secure environment and much more logistical planning, arrangements and manpower needed when external contractors were working in Prison institutions where the inmates were incarcerated. At the various Prison institutions, the Prison staff have to allocate manpower resources to facilitate the network installation works and setting up of the necessary IT equipment.
The implementation of PrisMS could not have been so smooth without the dedication and cooperation from all involved parties. They took bold steps in changing existing processes and modus operandi. During the initial few weeks, operations were affected due to unfamiliarity of the medical staff of the new workflow. Ad-hoc fine-tuning changes have to be made to make up for lost time. Nevertheless, with perseverance and conviction, within weeks, the overall efficiency of the medical processes greatly improved and Prisons began to benefit from this initiative.
|
|
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
|
PrisMS has significantly increased staff productivity. The medical staff saved considerable time as they need not prepare the hardcopies of medical records before each consultation, nor need to prepare prescription charts or to transfer medical records across prison institutions. All medical staff is able to access and update medical information of inmates anytime within the Prison premises. With the system, errors arising from manually recording and transcribing are eliminated. It also eliminated hardcopies lost in transit. The reduced movement of medical staff carrying hardcopy files and notes also improved the security of Prisons, as there was reduced opening and closing of the prison gates for staff movement.
The integration of PrisMS with Automatic Tablet Machine (ATM) has greatly reduced the time required to prepare the medication for inmates. Instead of manually packing the dosage for each inmate, the ATM received the prescription from PrisMS, and packed them automatically. SPS have successfully replaced the manpower required for packing with the use of the ATM. Currently, 6 pharmacists could pack over 6000 medicine sachets for more than 3000 inmates each day. With the use of handheld devices for medication dispensing, the medical staff need not prepare manual prescription charts, saving time and manpower in the process.
PrisMS could generate the statistical reports and medical reports with ease. Time was saved by having to collate the statistics and preparing these reports for submission and preparation of the medical reports. The report generated from PrisMS provide greater accuracy than the manual reports as not all medical staff would record the statistics correctly, due to the other numerous tasks on hand.
In addition there is reduced need for physical storage spaces to storage thousands of hardcopy files and drugs inventories in all the institutions.
PrisMS’ data interface with the other Prisons’ IT system not only improved efficiency, it also provided better management of medical in confidence information. Only authorised Prison staff are shown relevant information required for their management of inmates.
The system provides real time alerts to doctors when there are drug allergies or contra-indications to the diagnosis or other medications. Thus PrisMS has ensured the safety and high quality of medical service provided to inmates.
|
|
| 8. What were the most successful outputs and why was the initiative effective?
|
|
The entire project was managed using ISO 9001:2008 Quality Management System (QMS) adopted by Singapore Prison Service. The QMS is effective in guiding the project team in the project life-cycle of PrisMS and in ensuring the project was completed on time.
The project phases and the deliverables at each stage were clearly defined. There were guidelines on how to manage the project through proper record keeping and documentation and sign-off from the System owner and Ops manager. The project structure, roles and responsibilities of each team member were also clearly identified. It enforced regular meetings and feedback sessions with proper notes documented. The vendor submitted monthly progress report for SPS to monitor their activities and for adherence to the project schedule. All involved parties were fully aware of the project progress and critical timelines of the project. Hence the QMS system has greatly contributed to the success rollout of the system.
As part of QMS, the project team has also implemented a risk management System. The risks identified were constantly reviewed and updated at each project meeting to ensure that every risk is adequately mitigated. The risk management system has helped the team to identify issues early in the project and take appropriate actions to minimize the impact or likelihood of the risks occurring. Thus, the team has successfully avoided potential pitfalls that may incur high recovery cost, additional time and resources or the need for more funding.
The PrisMS project had undergone and passed 2 QMS audits to date. The first audit was conducted during the tail end of development stage, before the User Acceptance Test phase. The second audit was conducted 6 months after system roll-out.
|
|
| 9. What were the main obstacles encountered and how were they overcome?
|
|
Accuracy in Capturing & Usage of Medical Information
The capturing and usage of the medical information in PrisMS was critical in inmates’ medical diagnosis and their medication dispensing. Thus accuracy in the system was critical. Many rigorous tests were conducted on PrisMS and system interfaces to eliminate system errors and to ensure that the system function accurately to achieve its intended purpose. In all cases, human verification would be the last defence to eliminate any possible errors that might arise. For medication dispensing, parallel runs for the prescription chart was also done to test the robustness of the integration of the system with the ATM and handheld devices when packing and dispensing medication. At the various stages of project, the team worked closely with all stakeholders highlighting and resolving issues and system bugs.
Prisons’ Operational Constraints
The unique Prisons operations constraint was another main obstacle when implementing the system. The project team conducted site surveys to understand current setup and existing work processes and had to work around Prisons operations constraints. As PrisMS is a new system replacing manual existing processes, many innovative approaches and business process reengineering had to be done. New streamlined processes were developed and hence change management was done extensively to ensure adequate briefings and trainings.
Unfamiliarity with the System
As PrisMS was developed and implemented by SPS, the new Medical Service Provider was unfamiliar with it. Given that the medical service provider was to provide medical service to the inmates in SPS, it was critical that they be familiar with the system and able to utilize the various functions to perform their work. Various trainings and assessments were conducted for the medical staff and doctors. Additional manpower from Medical Service Branch was provided during the initial period at various locations across all three Clusters to provide support, to troubleshoot when there were issues and generally hand-holding the service provider often late into the night. As it is a new system with new workflows, much effort was put in to “sell” the new capabilities to soften resistance from ground officers. In addition, strong senior management support was instrumental to ensure commitment from all staff and has resulted in a smooth implementation of the system.
|