On 1st Nov 2020, more Singaporeans became eligible for subsidised or free NAIS and NCIS vaccinations for nationally recommended vaccines, as part of a Ministry of Health (MOH) programme under the National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS). These subsidies are part of efforts to “better protect Singaporeans from vaccine-preventable diseases and to reduce the risk of outbreaks in the community,” said MOH.

On 1st Jan 2021, patients with complex chronic conditions such as diabetes and dementia were able to withdraw up to $700 from Medisave accounts yearly, an increase from the previous amount of $500. The higher limit increases flexibility for patients with complex chronic conditions, as they are likely to incur higher costs.

What went on behind to ensure that the IT systems were ready for these changes? Let us take a look.

Enhancements at a glance:

• Enhanced NAIS and NCIS vaccination subsidies for eligible Singaporeans

• Changes to Medisave withdrawal limits for complex chronic conditions

• The processes and IT enhancements made to ensure a smooth go-live

• Challenges and how they were overcame

Ensuring that Singaporeans Can Enjoy Enhanced NAIS and NCIS Vaccination Subsidies and Medisave Withdrawals Easily

Even though there were no new functionalities added to the HealthTech systems, both enhancements were considered quite complex, as they had to marry the new policies with healthcare institutions’ current process and operations, which are highly interconnected.

It was also tricky to develop the new data fields and workflows correctly such that relevant data are captured and routed accordingly, as well as ensuring that these new fields integrated well into the overall system.

For the NAIS and NCIS Vaccination Subsidies, IHiS worked closely with all three clusters to configure six Patient Management and Patient Accounting (PMPA) systems on pricing/billing/charging rules, subsidy computation and bill presentation changes. Prior to the go-live, the team spent about a year doing the necessary preparation work that spanned public healthcare’s polyclinics and Community Health Assistance Scheme General Practitioners.

For Medisave, IHiS worked closely with all three clusters, the Ministry of Health (MOH) and Central Provident Fund Board (CPFB) to make the enhancements over a period of eight months. The enhancements made to 12 systems such as Patient Management and Patient Accounting, Sunrise Clinical Manager, and Pharmacy went live smoothly on midnight of 1st Jan, with more than 30 staff from IHiS ushering in 2021 by tracking the deployment closely to ensure it was going well.

The Process of Ugrading HealthTech Systems for NAIS and NCIS Vaccination Subsidies and Medisave Withdrawals

With both enhancements, the first few months were spent understanding the new policy and then gathering both high level and detailed user requirements. This was among the most crucial steps in the journey, as it laid down the foundations for the enhancements to be done correctly.

After gathering inputs from multiple stakeholders, the team at IHiS had a good idea of what was required and proceeded with drawing the corresponding plans and costings.

Once the approvals were received after several rounds of clarifications, the IHiS team then spent the next two months procuring the services and working with the vendors to make the necessary changes.

After the changes were made, another critical step known as System Integration Testing was done. This involves the overall testing of a complete system with many sub-components or elements, to ensure that the modification of one-subsystem does not unintentionally modify others, and that everything still flowed smoothly.

When that was completed, IHiS worked with healthcare staff to conduct User Acceptance Tests, where users’ feedback were further incorporated. In the Medisave enhancement, the IHiS team also had to work with staff from the Central Provident Fund Board (CPFB) to ensure that the enhancements integrated well with their systems as well. The enhancements were only deployed after the users are satisfied with the final product.

On the respective go-live days, a command centre closely monitored the systems and were ready to jump in with quick assistance if necessary. Thanks to the meticulous planning and implementation, no major issues were encountered for both, and more than 1,000 NAIS and NCIS vaccination subsidies were given out within the first few days.

Challenges Faced During the HealthTech Systems Enhancements

Every project has its share of challenges, and these were no different.

NAIS and NCIS Vaccination Subsidies

For many, COVID-19 disrupted the usual mode of working, and extra time was required to get used to non-traditional methods, such as online meetings. Staff from clusters and IHiS also had to grapple with additional pandemic-related workloads. The team overcame these challenges in part due to the quick implementation of communication tools such as Skype, as well as the perseverance, hard work and determination of everyone involved.

The tight timeline given for the HealthTech system enhancements presented another challenge. The first policy requirement briefing occurred about a year before the go-live date. While that may seem like a long time, it was actually relatively short, given that many teams of people needed to be involved, with multiple rounds of approvals from clusters, MOH and committees like Cost Review Assessment to go through. To get things off the ground and moving, a significant amount of coordination work had to be done.

The tight timeline also meant that changes could only be made to the billing system and not the clinical systems, as any changes to the latter require a lot more time to develop and test. This meant that patients’ eligibility for the subsidies are not automatically interfaced between clinical and billing systems, and would still require a doctor’s discretion to approve.

After multi-party discussions by the relevant stakeholders, it was determined to go ahead with the HealthTech system enhancements to the billing systems first, so as not to delay the timeline for the NAIS and NCIS vaccination subsidies. Work is currently ongoing to scope the required effort for the clinical systems to be enhanced as well as implementing the current system enhancements to Community Hospitals.

Flexible Medisave Withdrawals

Given the interconnectivity of Singapore’s public healthcare’s systems, any changes must be reflected in all the relevant systems – 12 in this case. This required a lot of coordination and collaboration from staff managing the different systems, especially given the tight timeline.

Halfway through the process, due to the changes in funding approach, the project team found that they suddenly had to go through a lengthier approval process that involved the Solution Review Board and Cost Review Assessment. These typically take at least three months to go through, and could have potentially pushed the timeline back significantly, leading to a delay in rollout.

How IHiS Overcame These Challenges

The IHiS team overcame this challenge by working extra hard, especially with colleagues from IHiS’ Chief Architect Office on the SRB and CRA, to expedite the process to keep to the original timeline, so that Singaporeans could receive better Medisave enhancements on time.

The overall smooth implementation was made possible due to the strong support from the various Chief Information Office teams to expedite approvals and address operational issues; some teams even worked through weekends and public holidays in order to meet the timelines. The IHiS project team would also like to thank all healthcare staff involved in making these system enhancements a success.