team alpha final presentation 16 april 2018 · final presentation 16 april 2018 1. prof tan hwee...

Team AlphaFinal Presentation

16 April 2018 1

Prof Tan Hwee PinkSponsor Wolf

Associate Professorof Information Systems

(Practice) at SMU

He is also the Academic Director at SMU-TCS iCity Lab

Prof Tan Hwee XianSupervisor Wolf

Assistant Professorof Information Systems

(Practice) at SMU

Part of the SHINESeniors(Smart Homes and Intelligent

Neighbours to Enable Seniors) project team

Dr Raj Vikesh Tiwari S/O PKTChief Resident Wolf

Chief ResidentDepartment of Urology

Singapore General Hospital

Recently won the SingHealth Surgery Academic Clinical Program (ACP) innovation

grant for the study of Visual Analogue Uroflowmetry Score

(VAUS)

2

Dr Henry Ho Sun SienSenior Consultant Wolf

Head of Department,Urology Centre

Singapore General Hospital

Well renowned senior urologist with an interest in

voiding disorders

STAKEHOLDERS

BENIGN PROSTATICHYPERLASIA

… most common prostateproblem for men older thanage 50 (NIDDK, 2014).

50%Between Age 51 – 60

(NIDDK, 2014)

90%Aged 80 and above

(NIDDK, 2014)

Dr Valerie Gan, a Consultant Urologist at the Department of Urology, SGH mentioned that in 2010, BPH affected

210 million men worldwide (Choo, 2017).

Dr Gan also related the prevalence of BPH to Singapore, in which the prevalence of BPH has increased from 14% to 16.5% from 2005 to 2012 (Choo, 2017).

3

Family Clinic

4

Polyclinic

Hospital TCM Clinics

SGH Urology Center

Serves an average of 450 patients per day

5

However…

Requires medical/surgical treatment

10%of men with BPH

Only this group needs to visit hospital for

treatment(SingHealth)

1 uroflowmeter costs ~SGD $15k

Due to its expensive cost, polyclinics do not have the

equipment to measure severity of urology diseases

Patients without the need for surgical

treatment still have to travel a long way to the

hospital6

SGH Urology Center

Serves an average of 450 patients per day

7

UroflowmeterA device that

measures the speed and quantity of

urination

Uroflow ResultVoided volume (ml) and Max speed flow (ml/s)

Prints out the uroflow result after patient

urinates into the uroflowmeter

8

9

International Prostate Symptom Score (IPSS)

Urinary symptoms questions

Quality of Life question

71

Internationally validatedin various languages

中文

Bahasa Melayu

English

Scoring system used to screen for and diagnose benign prostatic hyperplasia (BPH)

Designed by:Dr Henry Ho Sun Sien, and

Dr Raj Vikesh Tiwari S/O Pkt

10

Visual Analogue Uroflowmetry Score (VAUS)

Visual-aided question

Scoring system used to determine the severity of symptoms faced by BPH patients

1

11

International Index of Erectile Function (IIEF-5)

ED is classified into five categories based on the scores:

Severe (5-7)Moderate (8-11)

Mild to moderate (12-16)Mild (17-21)

No ED (22-25)

Scoring System and diagnostic tool for erectile dysfunction (ED)

5 ED questions

Patient (Males >= 50 years

old)

Staffs

Registers and obtain

queue number

Proceeds to take uroflow

test

Biostatistician manually keys in each patient’s result into an excel sheet after

nurse passes the result to her

Manually writes down patient’s result

Attempts the IPSS, VAUS

and IIEF

Approaches the nurse for

assistance

Submit questionnaires

to the nurse

Sees the doctor

Start

Ready for uroflow?

No

Yes

Assistance?

YesNo

More Assistance?

No

Yes

Consolidated 50?

Yes

No

Passes patient’s completed questionnaires and uroflow

result to the doctor

Process continues next slide

13

Yes

No

Completed uroflow?

Yes

Completed questionnaires?

No

Difficulty in reading and understanding

the medical questionnaires

“cannot see”

Lengthens Process Lack of PlatformHectic Schedule

High workload“During peak period, nurses have to administer 3-4 patients at any one

time”Time-consuming

Nurse manually calculates patient’s key medical parameters before

writing down onto a piece of paper

Lack of a platform to capture, consolidate and analyse men’ urological health information

across health clusters from primary to tertiary care, which

allows for a seamless transition of care for BPH patients

15

PROBLEMS

On Site Observation

:: Elderly

20 observations at

SGH Urology Centre

17 Jan 2018 : 9.30am - 12pm

23 Jan 2018 : 9am - 11.30am

ObjectiveMeasure the time taken for patients

to attempt the paper-based

questionnaires

2 times

Time taken per Patient

10.46mins

Average number of timeshelp is sought

Results of observation

16

8 interviews at

SGH Urology Centre

8 Dec 2017 : 10am - 12pm

14 Jan 2018 : 10am - 11am

ObjectivesDiscover their pain points and find out

the kinds of question asked by patients

3-4 patients

Results of interviews

Inconvenience when filling up the

questionnaires

17

Interviews

:: Nurses

Vision problems

19

UroHealth is a stepping stone towards the vision of SGH – nationwide platform which provides a one-stop solution for men’s urological health as patients can get managed in primary care (polyclinics etc.)

settings as well.

UROHEALTH

On-The-Go Multi-Language Translations

Pinch-To-Zoom Magnifier Gesture

Real-Time Access to Patients’ Test Results

Statistical Visualization and Analysis of Patients’ Results

Prove that VAUS is a good representation of IPSS and Qmax (Uroflow Result)

Increased usability

Senior friendly app

Patient able to smoothly attempt and complete the

questionnaires with minimal or 0 help from

others

Reduce workload

Decrease number of times patients seek help due to visibility of the

questionnaires

Less time consuming

Eliminates the need for nurses to total and record patients’ score manually

Easy and convenient

Allows doctor to easily retrieve patients’ urological

information for analysis and visualisation

20

VALUE-ADD

Nurses

Elders (Males >= 50 years

old)

TO-BE PROCESS

21

Registers and obtain queue

number

Proceeds to take uroflow

test

Attempts the IPSS, VAUS and

IIEF on iPad

Approaches the nurse for

assistance

Submit questionnaires

Patient’s result get transmitted to the web app

Start

Ready for uroflow?

No

Yes No

More Assistance?

Nurse keys in patient’s ID

into the iPad

Assistance?

Yes

Checks new patient? Yes

Nurse registers

patient on iPad Uroflow result

ready?

Nurse input uroflow result

on iPad

Yes

No

Mobile application

Process continues next slide

DEMO

23

24

ARCHITECTURE DIAGRAM

Data LayerApplication Server

JDBC

Mobile Application

JSON Response

Invoke REST API

25

TECHNICAL COMPLEXITYOptical Character Recognition (OCR)

1) Utilizing Google Vision, we will extract the printed uroflow result using the iPad camera

2) Populate the uroflow results (Accuracy = 50%)

OCR will scan the

results

Populate the

uroflow entry

Upload into

medical system

• Personal Data Protection Act (PDPA)

• Reasonable security arrangement to protect personal data

• Prevent unauthorized• Access• Collection• Use• Disclosure• Copying• Modification• Disposal

26

TECHNICAL COMPLEXITYSecurity

• The security of patients’ data is the most important aspect of our project

• Our application captures and stores:

Identity Card (IC) Numbers Medical Records

27

IMPORTANCE OF PDPA

• Users must be logged-in

• Maximum Tries on each Account (Locked Upon Limit)

• Access control (Doctors cannot access admin pages)

• Password complexity (Length, characters, special characters, casing)

• Sensitive information is encrypted

• AES with 128 bit key (Identity card number)

• BCrypt hashing (Passwords)

• Design

• Only data from trusted source are displayed (Database)

• Input sanitization

• Any data going into the database such as patient / user Registration

Authentication, Authorization and Passwords (Part 2:7.)

Databases (Part 2:13.) Web Application (Part 2:15.)

Personal Data Protection Commission

(Guide to securing personal data in electronic medium)

28

FEATURES IMPLEMENTED

29

EXAMPLES OF IMPLEMENTION

Sensitive information is encrypted

• AES with 128 bit key (Identity card number)

• BCrypt hashing (Passwords)

HTTP Secure

• Providing actionable insights for the urology department

Correlations Charts Insights

30

TECHNICAL COMPLEXITYAnalytics

31

TECHNICAL COMPLEXITYAnalytics – Correlation Summary

Fields in the given data (1009 records):• Age• Qmax• Voided volume• IPSS score• VAUS score

• Added in: Patient’s education level• Conducted correlation comparisons between 2 sets of data:

• The given data VS our collected data

Before the start of our FYP…The SGH urology department has collected 1009 anonymized patients’ records.

During our FYP…The team collected a total of 93 anonymized patients’ records.

32

TECHNICAL COMPLEXITYAnalytics – Correlation (Given Data)

Main Insights:• IPSS & VAUS are negatively-related• Qmax & VAUS are positively-related

Interpretation:• Proves that VAUS is a good indicator of IPSS and Qmax (Uroflow Result)

33

TECHNICAL COMPLEXITYAnalytics – Correlation (Collected Data)

Main Insight:• IPSS & VAUS are negatively related (Coincides with provided data)

Interpretation:• Proves that VAUS is a indeed a good indicator of IPSS

34

TECHNICAL COMPLEXITYAnalytics – Correlation (Collected Data)

New Insights:• The less educated the patient, the higher (worse) the IPSS score.• Possible reason: Unaware about the symptoms about BPH, seek treatment late

Actionable steps:• The hospital can have more awareness campaign to educate the elderly about BPH

35


Insights:

• With the addition of IIEF, each patient will now hold onto the Ipad for about an additional 0.87 minutes.

• Addition of IIEF takes longer because:1. Questions are sensitive in nature2. Extra questions to answer

Actionable steps:

• Helps to determine how many Ipads to purchase in future if there is any additional questionnaire

36


Insights:

• Patients take longer time for question 1,2 and 3

• Reasons:1. Troubles

understanding the options

2. Unfamiliar using Ipad

Actionable steps:

• Nurses can pay more attention and assist patients when they start on IPSS

37

Patient’s ID page

QUALITY OF PRODUCTUsability – Product Design Process

Before After

38


Main MenuBefore After

39

Uroflow


Before After

40


QuestionnairesBefore After

• Used Apache JMeter

• Tested up to 140 concurrent users

• 16 tertiary hospitals + 18 polyclinics = 34 locations

• 34 locations * 3 iPads each = ~ 100 concurrent usage

41

QUALITY OF PRODUCTPerformance – Load Testing

42

QUALITY OF PRODUCTPerformance – Load Testing

1585

3387

4328

6806

8167

9856

11843

0

2000

4000

6000

8000

10000

12000

14000

20 40 60 80 100 120 140

Av

era

ge

La

ten

cy (

in M

illi

seco

nd

s)

Number of users

Load Performance

• Concurrent testing

• Started with 20 users

• 2 tries per user

• Successful connections with 0% errors

43

QUALITY OF PRODUCTRegression Testing

• Product is tested at the end of every iteration• Total: 200 Test Cases

USER ACCEPTANCE TEST (UAT) SUMMARY

UAT 1 2 3 4 5 6

Date 2-3 Feb 6-10 Feb 13-16 Feb 14 Feb 14 Feb 12 Apr

Number of participants

15 35 35 5 4 6

Tested onProject SHINESeniors’s

elders

Elders @ Chinatown/ Community

Centers

SGH Nurses SGH Doctors SGH Doctors

44

UAT Web App (Doctors)

SGH Urology Centre

12/4/2018

Objectives

Testing Venues

Gather feedback on the web application based on the

developed functionalities

To determine the usability of the application

~ 15 minutes per doctor

6Doctors

45

UAT RESULT (DOCTORS)

46

>= 4Target average score for each goal

▪ Goal 2 missed target score by 0.17; presentation of data layout could be better

▪ Average score for “retrieval” & “design” of the app has achieved and exceeded our target

Average Score = 4 Average Score = 3.83 Average Score = 4.33

UAT FEEDBACK - DOCTORS

• General• Web interface design is good

• Correlations & analytics are meant for research teams rather than doctors

• Specific • Summarize points to view everything on one

glance (Too many tabs)

• Displaying of data could be better positioned

47

CHANGES FROM UAT (BEFORE)

48

(AFTER)

49

CHANGES FROM UAT

Core Functions – Mobile Application

Core Functions – Web Application

50

PLAN VS ACTUALCORE FUNCTIONS

Account Module

Analytics Module

Clinical Parameters Module (Mobile App)

Medical Record Module

Data Migration/ Contingency Module

Security Module

Advanced Search Module

Admin Module

Core Functions – Mobile Application

Core Functions – Web Application

Account Module

Analytics Module

Clinical Parameters Module (Mobile App)

Medical Record Module

Data Migration/ Contingency Module

Security Module

Advanced Search Module

Admin Module

Planned Actual

No change

51

PLAN VS ACTUALSECONDARY AND TERTIARY FUNCTIONS

Secondary Functions

Data Extraction Module

• Use API to extract all/specific data from our web application system

Tertiary Functions

Data Extraction Module• Use API to extract

all/specific data from our web application system

Uroflow Integration Module

•Optical character recognition (OCR):Uroflow results to the web application system

Ultrasound Module

•Patient’s ultrasound image to the web application system

Physical Security Module

•Alert when iPad leaves the vicinity of the clinic

Secondary Functions

Data Extraction Module

• Use API to extract all/specific data from our web application system

Tertiary Functions

Data Extraction Module• Use API to extract

all/specific data from our web application system

Uroflow Integration Module

•Optical character recognition (OCR):Uroflow results to the web application system

Planned Actual

Evaluate the feasibility and impact of the

change request

Inform change requestor and

other stakeholders that it is accepted

Update change

request list to accept

Decide priority of the

change request

Implement it

Inform change requestor and

other stakeholders of

the rejection

Update change request list to

reject

Receive change request

Accepted?

End54

CHANGE MANAGEMENT

55

#Initiated

byIteration Change Description

Estimation of Impact

PriorityAccepted or

RejectedReasons Status

1 Client 3Add in International Index of

Erectile Function (IIEF-5) Questionnaire

Low 2 AcceptedWorkload was still manageable at the point of

requestCompleted

2 Client 7Combine the 3 questionnaires (IPSS, VAUS and IIEF) together

Low 2 AcceptedAgrees that it would be more hassle-free if we

allowed the patient to move forward and complete the 3 questionnaires at one go.

Completed

3 Team 8Hopes to receive an alert if the iPad leaves the vicinity of the

urology centreMedium 1 Accepted

Concerned for the physical security of the iPad. Prevents patient from exiting the clinic

with the iPad stealthily

Scheduled at a later iteration

4 Team 9Keeps track of the time taken to

complete each question and each type of questionnaire

Medium 3 AcceptedMeaningful to capture and analyse the time

that men of different ages take to attempt the questionnaires

Completed

5 Team 10 Skip functionality Medium 3 AcceptedNeeded to provide a means to skip the section

due to its private contentCompleted

6 Team 10 Chinese and Malay IIEF Medium 3 AcceptedProvides a more holistic questionnaire

experience; do not neglect those who cannot understand English when we design our app

Completed

SCOPE CHANGE (BEFORE MIDTERMS)

56

#Initiated

byIteration Change Description

Estimation of Impact

PriorityAccepted

or Rejected

Reasons Status

7 Team 11Remove Ultrasound

ModuleLow 2 Accepted

Checked against the ultrasound models given,

none had wireless capability

Removed

8 Team 12

Add Word Lookup Module as we hope to

help improve the patients to understand

the questions by providing vocabulary

helps

nil nil Rejected

Since the questionnaires (IPSS, VAUS and IIEF) are internationally validated, the doctors (client) said

that it is not appropriate to provide any

meanings/descriptions to the questions

nil

9 Team 13Drop the physical security module

(tertiary function)nil nil Accepted

Due to a delay in some tasks, there is insufficient

time for us to complete this tertiary function.

Dropped

SCOPE CHANGE (AFTER MIDTERMS)

Risk type Description Likelihood Impact Category Mitigation Plans

Non-technical(Usability-Elders)

Difficulty in relating to how the elders will feel about the mobile

interface we have builtHigh High A

Went to the public to search for elders to provide feedback and review on the mobile

app interface for our UAT

Non-technical (usability-nurses

and doctors)

Difficulty in relating to how the clients will feel about the product

High High AInclude more feedback session with our

clients to request for feedback and review on the product

Equipment iPads that we loaned from our client got damaged accidentally by users

during user testingMedium High B

Take extra caution. During user testing, ensure that the users attempt the survey in

a supported environment (e.g. tables)

Unforeseen circumstances

Team member’s personal reason (compassionate reason etc.) which

results in him or her being unavailable to complete the tasks

Low Medium C

Team members encourage each other and help out if needed. All members attend all team meetings and tasks assignment will

be made clear to everyone.57

RISK MANAGEMENT

100%

80%

87% 88%

67%

92% 91%88%

86%

92%

82%75%

92% 92%

100%

50%

60%

70%

80%

90%

100%

110%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

TM

sco

re

Iteration

Iteration 5 (67%)Light iteration in iteration 5 with 3 tasks. Unable to complete 1 task due to IRB not

approved yet

58

TASK METRIC

Iteration 12 (75%)Uroflow Integration Module

Delay in task due to the inability to activate the camera for the OCR task

Iteration 11 (82%)Clinical Parameters Module

Delay in task to upload photo of uroflow results for documentation

01

18

7

0

8

5

12

7

20

7

11

78

1

0

5

10

15

20

25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Bu

g S

core

Iteration

Bug Score

59

BUG SCORE

Iteration 3 (18)Data collected on the iPad cannot be sent

to the database

Iteration 5 (0)Light iteration. No new functionalities

assigned

Iteration 10 (20)Focused on improving the interfaces’

changes raised by clients

X-FACTOR

60

10 patients’ usage

of the mobile application

3 nurses’ usage


Reduce process flow time

by 15%

X-FACTOR - RESULTS

61

13 patients’ usage


4 nurses’ usage


Reduce process flow time

From 10.46 min to 3.44min (67%)

62

HANDOVER

23 April 2018 9 am

• Source codes

• User guide for web application usage

• User guide to set up Amazon Web Service (AWS)

• Technical documentation

TEAM REFLECTION

• Challenging yet enriching and fulfilling

• Overcame the uncertainties and unfamiliarity when it comes to empathizing with the elderly

• Acknowledged our growth in both the technical and project management aspects

63

LEARNING OUTCOMES

64

• Learnt that interacting with the team and the stakeholders is important in allowing a collaborative environment

• It was an eye-opener for me to be able to witness the elderly' usage of the application, and also think of ways to improve the

application UI/UX in order to address their needs.

• In charge in designing and structuring the project architecture.

• Really understand that the client's persona, with an application for a medical organization, the requirements, the security is

immensely different from normal Business-To-Consumer apps.

Project Manager

Lead Developer

65

• Able to apply all of the skills I've learnt throughout the three years in SMU and my polytechnic years.

• More confident front end developer that is ready to embark on many more projects in the working world.

• All about learning on-the-go and constant effort & time in experimenting.

• Learnt to adapt to the fast-pace momentum and build my resilience to pressure.

LEARNING OUTCOMES

Front-End Developer

UI/UX Designer

66

• The insights and perceptions received were unique to this project, and could not been taught in a classroom.

• Better understanding on applying analytics with actionable insights.

• Felt confident that the project would be smooth-sailing but after several iterations, certain functionality were not as easy as

it seem to be.

• Most functionalities may have online help to be easily achieved, business constraints could severely affect this and force us to

look for alternatives.

LEARNING OUTCOMES

Analytics and QA Analyst

Back-End Developer

team alpha final presentation 16 april 2018 · final presentation 16 april 2018 1. prof tan hwee...

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