SIMATS Best Practices
Paperless Hospital
SIMATS offers consultancy to may dental colleges for protocol development and faculty training to follow our
MILA and Comprehensive clinics. We also offer our hospital management software as a service through our incubation centre.
1. Title of the Practice:
“A model paperless dental teaching hospital system in India” A Pioneer even at a Global scale”
2. Objectives of the Practice:
The goal was to eliminate paper records from registration to discharge.
The system had to be convenient, easy to monitor and designed for student training.
It had to be scalable for us to have enough data points for retrospective studies.
Another goal was to establish a balanced rubrics that considered quality and quantity to determine clinical competency.
Collect and archive photographic records, 3d models, radiographic files, dicom files, consent forms, prescriptions, billing, lab work, student grading, material audit all in one page.
Provide options to evaluate students, faculty and system performance.
To guide early clinical training by suggestive forms to ensure good clinical practices.
3. The Context:
There are many hospital information systems developed and marked across the world. Most of these systems are usually plagued by a single flaw. That is, it is designed with the MRD as the central unit. The doctors or the students are not in the centre of the software design. Therefore the resulting system will be difficult to use and probably require another assisting to be employed just to enter the data.
Our approach to this problem was to use a touch-friendly tablet based system that is more sterile and easy to use in a hospital environment. As with any new venture, scaling, costing and even understanding what we want took some time. We started with the ‘RMS’ (Record Management System) and learned how not to design a HIS system. It was useful, but could not fulfill all the 7 goals mentioned above. Furthermore, dental records are very pictorial and require people with better developmental knowledge to deploy such a system. Apart from the software, back then, we faced tremendous challenges in establishing the hardware ecosystem. For example, when more than 30 ipads are in a room, weird interferences happen, dragging the network to a screeching halt. The network had to be reset frequently to solve this issue, only after installing an advanced load balancer and a AAA Server were we able to solve the issue.
4. The Practice
So, Armed with all the knowledge and experience, we decided to deploy a new software that would be fast, light and robust in the .net platform. The system was designed with a student centric approach. Ample effort was made to mimic the physical record/ workflow a student or a doctor will face in a day-to-day practice. Then we designed an approval system, with large format image review for easy grading, we made most treatments dynamic forms allowing extraordinary flexibility in creating case sheets. For example, if our aim is to train a student about a new classification, we can just add it through to the Clinical dean’s login into all case sheets on the fly. The next time the student examines a particular case, they will automatically be asked to mention the classification leading to subconscious learning. The system was well received, we had minimal teeth issues and the photographic review was excellent. We added many quality parameters like faculty approval time, patient wait time, student speed, student case completion court, students weightage scoring, free credits for poor patients, an e-wallet with automatic cash deduction in treatment approval to avoid financial mismanagement and so on.
5. Evidence of Success:
Right from the day of introduction, this homegrown system was a rapid success. It overcame all the limitations of the previous system and also had tremendous scope for new ways students and faculty could use to improve the learning outcomes. Since the clinical work is on display, students developed a habit of looking at each other's work and appreciating their skills. Now there is a culture of obsession to do high quality work and document it to their pride. Apart from quality, the system has also improved the efficiency of patient care. This is evident by the lack of medicolegal cases in the last 3 years. Even if they arise, the photo documentation resolves all the issues.
Performance wise students have also developed an acute interest to increase the performing maximum cases. The formative scoring, GRB ( graduate record Book) of clinical cases work around Dias to take it a full circle from students training to performance analysis. Faculty approvals times have reduced meaning patients are also getting faster treatment. Now, the system is a massive success, that 9 institutions signed MOU for training. We started an Incubation centre called Viana Soft™ and have signed deals to supply training, protocol and manage the recipient college for a year. The DCI has also requested us to design parts of the curriculum and establish clinic protocols across the country. All of these prestigious events happened because of our ‘DIAS’ Dental Information Archival System and its ability to ensure comprehensive clinical training.
Dias has also improved our research footprint, with the click of a button, we can get very specific prevalence data among 2 lakh patients - like the average number of failures that occur among patients with the right upper first molar tooth when treated with a particular restoration material. Such data collection was impossible in the traditional sense. Currently we have over 600 publications based on such data in 2020 -2021 alone. This has also translated into our institute having 19 dental researchers among the top 2% scientists in the world. This is more favourable compared to Hong Kong School of Dentistry ( Current No1: Dental School in the world) who has only 14 Top 2% scientists which has been widely publicized as a great record for them. So we can confidently declare that Dias has made the system more efficient, our patients more happy and our faculty more proud!.
6. Problems Encountered and Resources Required.
Speaking of limitations, integrating dicom pacs servers has been a rough transition, also radiographic technician entry panels were sub optimal. The next major challenge was facing the NABH inspection, where paper documentation of consent forms to prescriptions were mandatory and traditionally expected. Although it was very difficult, we convinced the inspectors by adding video consent forms, pretreatment consent forms and digital signature system. Currently we are the one and only institute in India to get NABH certified under the inpatient handling hospital category.
7. Notes:
Certain things to be noted while implementing a software system:
Although software can help reduce consumables, it will not be less expensive.
Such a system should be incorporated completely from the reception to discharge to actually bring in the changes we felt in our system.
There will be huge resistance in such a sudden transition, however the best way seems to be abrupt. When we guide other institutions in a slow transition process where they try to retain both manual and digital records, it ends up becoming worse than either system. Therefore our recommendation is to be abrupt, deliberate and quick.
Our system has rigid fail-safes, for example it will not be possible to do a treatment without a thorough diagnosis and treatment plan approval. This intentional design choice was made to ensure proper training of our students. It may feel uncomfortable in the beginning, but these features should never be compromised or else the entire database will risk being filled by useless corrupt clinical data.
“Study Flex MILA™ Frame-Work”
1. Title of the Practice:
“Study Flex MILA™ frame-work” - small group interactive CBCS system, a universal implementation of a robust framework.
2. Objectives of the Practice:
To Implement CBCS across all our programs in the university
To create a universal framework that can be suitable for students of all programs to allow for interdisciplinary courses
To design a software to streamline the entire academic process from enrolment to convocation.
Integrate lab and theory classes in learning centres we call “CLABS and CLAFFS”
Avoid falling into a timetable trap trying to accommodate multiple courses.
On a convenience stand point, we wanted to design the system so that college hours do not need to be modified from a traditional system.
Reduce the workload by decreasing the no: of subjects at any point of time.
Provide space for quick progression, providing more time for field and internship activities that improve placements.
Not to lock the system by keeping too many prerequisites that would eventually kill the spirit of CBCS.
Architecturally integrate infrastructure, academic, student and faculty requirements into a simple universal plan that can be feasible for all types of programs.
3. Context:
When the mandate to introduce CBCS across all programs was stipulated by the UGC, we faced a lot of resistance from students and faculty in transitioning to the new system. The most common remark was “It may be suitable for Engineering discipline but it is not suitable for other disciplines”. Hence, we faced a major challenge in implementing a common universal CBCS across all our programs. We tried various strategies to optimise the system to satisfy most of the disciplines, this rich experience enabled us to design a robust CBCS system that is very effectively being followed in our LAW, Management, Arts and Architecture BPT, BOT and Engineering programs. The “ Study Flex MILA ™” system involves CBCS integrated with alternate styles of pedagogy and class room infrastructure modifications that make it applicable across clinical, practical and didactic sessions. This makes the system suitable for any program. We have also tried to incorporate a few components of this system in the PG medical and dental curriculum. Based on its success, we have been entrusted by the DCI to design a CBCS curriculum framework to be implemented in the next academic year.
4. The Practice
We developed a software called the Academic Record Management system (ARMS) to execute CBCS course allocation in the university. The software is flexible, and allows for tremendous innovation in the teaching learning process. The college hours are divided into slots. Each slot spans over a 90 minute duration. We are very passionate about small group teaching and so we limit our class sizes to 30 students. Since we had constructed the class rooms for 60 students, we converted the extra space into CLABS or hybrid class room + lab learning space. Each CLAB has 2 faculty staff cubicles, a 30 seater class set up and another 30 seater lab setup. These facilities are provided over and above the requirements of the AICTE regulations and was appreciated during inspections. Similarly, we converted the class room of 60 into a CLAFF room learning centre of 30 students and few faculty stations.
We invented a learning method called MILA ™ (Multiple Interactive Learning Algorithm) that being followed across all our programs. We have published extensively on achieving high performance and low student fatigue with this teaching protocol. In this technique, pedagogy is made more effective by having a 90 minute sessions split into 3*15 minute activities spaced out with lectures not lasting more than 18 minutes. Our scientific rationale was to maintain cognitive attention throughout the learning slot by introducing an active learning environment.
Based on our previous research we identified 9 interactive activities sequenced in a certain order for the best student learning outcomes. Since each CLAB contains 2 faculty, each faculty covers alternate slots while both faculty can help in the activity session. Essentially the faculty own the class room like their home, the students enter different classrooms for each session like guests. Since lab and class rooms are integrated, we do not need complicated lab schedules or large scale class room. This system allows the institution to have universal room designs that call all become learning centres suitable for any kind of training barring a few exceptions. Although, it may appear more expensive to develop a facility suitable for the Study Flex MILA ™ system, in practice the total built up area and investment is not dramatically different.
5. Evidence of Success.
The success of MILA was palpable across 5 domains, namely 1. Average student performance, 2. Improvement in students academic satisfaction or DREEM score, 3. Improvement in faculty productivity, 4. Improvement in student interactions, confidence and 5. increased demand. Average student performance: We have published over 180 publications on the impact of MILA Study Flex system. Generally we found upto 13 point jump in academic scores before and after the introduction of the Study Flex - MILA Framework. Student satisfaction and performance in viva and practicals were distinctively better reinforcing our belief that the system is effective. These measures were observed in medical subjects like Physiology and Biochemistry; Dental subjects like periodontics and prosthodontics; even engineering subjects like mathematics where activity based learning is not considered to have much scope etc. We also did the Dundee Ready Education Environment Measure (DREEM Questionnaire) a standard tool to measure education environment. In this questionnaire we improved from a score of 127 to 153. This is a remarkable increase as most TLP measure result in 5 point change. Primary domains that improved were students academic self perception and students perception of learning. Other indirect parameters of success in include positive students feedback, better word of the mouth, improved demand for the courses. We have been invited as paid consultants to 11 institutions inclusinf Dr. DY Patil Vidyapeeth, Pune, Amrita School of Dentistry Kochi etc. to train their faculty in the MILA protocol. Overall MILA + Study FLEX + Infrastructure developments = Winning formula for SIMATS.
6. Problems encountered and resources used.
Introducing CBCS in disciplines like LAW was one of the most difficult tasks under taken by the university. Initially the system was followed in a more traditional sense without the horizontal and vertical mobility of CBCS. In 2018 we converted to a completely flexible system. Initially, Students were overjoyed by the choice and everything seemed to do well for the first few months. However, due to paranoia and misinformation students protested the implementation. The issue required legal intervention to ensure normal functioning of the institution. After series of multiple counselling sessions we could continue the system with an albeit skeptical student body. However, as they started progressing faster and began to enjoy the longer internships, the students become more convinced and now Saveetha School of Law can proudly claim to be one of the few school to follow complete CBCS style curriculum. It is notable that CBCS was tried for law in Gujarat and Delhi, but it failed due to student protests and was eventually withdrawn. With robust software, customised infrastructure and a simplified schedule based on slots that never overlap, we were able to successfully implement CBCS ( in practice and in spirit) even in our Law discipline. Today this has become the hallmark of success for our LLB programs raising its profile to be ranked 13 in All India NIRF 2021. A significant achievement in a competitive landscape!
7. Notes:
There are a few consideration that are required to successfully implement the curriculum across multiple programs.
Clean documentation and student progression counselling helps student not panic when they are faced with unexpected results.
Having fixed slots and treating each slot like a bucket makes it easy to do a course survey and allocation.
Although students can choose their subjects and faculty, we recommend they do not leave unselected slots to avoid disciplinary issues.
An untold issue that raises in CBCS is the ego of a senior being bruised when they participate in mixed progression sessions. Advanced counselling and priming the senior students will help.
Supporting Documents:
Link of the best practices in the Institutional web site
Link for additional information
Any additional information
SIMATS A PIONEER IN UG RESEARCH.
SIMATS was the pioneer to start UG research project in 2012. We are the only institution in India where each UG participates up to 24 research project s and published upto 20 of them. Our vision was to compete with international universities. Back then we did not have the public or private funding to advance research. Hence we believed there are many day to day problems that require simple solutions. We planned to systematically address these problems with a proper protocol and clinical research. Similarly we did a lot of empirical studies where students visited the public and captured the state of the society. Over time, we were able to publish many of our papers and this become a strong motivator fo the students to achieve more. We have second year undergraduate students publishing in 3.6 + impact factor as first author. Such academic freedom is not common in other institutions. 100% of our UG publications have UG as the first author. Today Saveetha stands tall on the unique legacy of our UG publications. We are thankful to our hardworking students who have stamped their names int he history of the institution. Looking back
It all started with our dental school where every Dental UG students published around 5-8 papers / year. They were given freedom to select their own guide and perform research. We usually complete our didactic courses early and invest the time in research rather than on observation notebooks or chart work. This protocol was a tremendous success and we implemented the same in other institutions namely engineering, law and medicine. To improve the aptitude to research and to reduce economic burden , we train all our students with SPSS and research methodology SPSS on their own, have a proper PICO, Pre-hoc power calculation, and very systematically executed research. And ultimately this has improved the research culture, atmosphere and quality of research and finally the outcome of research across the University. Students actively pursue funding sponsors to who they make vibrant presentation and seek support. Our concept of decentralising knowledge has produced a vibrant community of SPSS wizards who perform advanced stats with ease! Furthermore, to motivate young students we began a formative assessment for research added to all courses. This system is similar to an academic bank of credits where in the students research scores are pooled and assorted to each subject by the student. Currently our Law program has 40 marks for research in all courses and dental program carries over 100 marks for research. This translated into a powerful research culture. We celebrate research with our Saveetha Transdicsiplinary annual research summit ( STAR SUMMIT). STAR SUMMTI has been successfully conducted fo engineering , law and dental students for the past 8 years. Here we invite faculty and scholars from other institutions as judges to evaluate the quality of research. Each students is trained to speak to at-least 50 + evaluators. We believe this is the single most important turning point for students to develop confidence.
The exercise started as an awareness attempt and later evolved into a passionate stage to exhibit ones project. Every year students usually present around 4000+ projects in their respective college star summits. Some students achieve large grants upto 1 lakhs to do research. This concept of undergraduates doing sponsored research project is unique to Saveetha. This has increased our publication foot print. We can confidently say that upto 35% of our publications arise from Undergraduate projects. Our UG’s have also won the famous IADR Hatton Scholar ships and travel grants worth 2000 dollars almost every year. The institutions also have many fail safe mechanisms to ensure that the quality of the research is maintained. We do have more than 1 crore worth subscription to Journal databases, students also use Turnitin and Google Docs based plagiarism tools to ensure originality. Although softwares are useful only to an extent, we take things a step further by conducting a research exam. This is a blinded exam. The student can bring a booklet with PICO analysis and citations. They have a 4 hour exam where they are expected to articulate their thoughts into a 1500 word hand written manuscript. This is corrected by the faculty and then typed into google docs. All our faculty and students use paper pile bibliometrics software and the institution has a paid subscription. After the manuscript is corrected by the guide, it is forwarded to the mentor to check for common protocols like title page, cover page and affiliation errors etc. Then the manuscripts are forwarded to a team of 40 peer reviewers in each institution. They will evaluate the manuscript and finally the dean meticulously reviews the sheets and processes them for publication. Hence, the quality of manuscripts are extremely well standardised. In fact a Saveetha UG paper can be distinctively identified from a random bundle. Our faculty have invested thousands of hours to achieve this quality. Each undergraduate from Saveetha Dental College will have a minimum of 10 publications in Scopus. Apart from this we have also inculcates a rich culture of innovation among our UG’s, they have published over 10 patents in the last 2 years. We believe our research protocols, research exam, multi level vetting standardised booklets for structure paper preparation training in SPSS all come together to make our training unique and stand out distinctively from others.
Rankings:
TIMES world ranking has ranked SIMATS as Number 1 in Tamil Nadu
Saveetha dental college is ranked 3rd in NIRF ranking among 300+ dental colleges by the Govt of India
SIMATS has been ranked with band A by the ATAL ranking
SIMATS has received the diamond rank by the QS-IGUAGE ranking system.