The first go-live in the South of England of a pivotal
part of the NHS's £6.2bn national programme for IT (NPfIT) has
caused significant disruption at a hospital in Oxford and put the
safety of patients at potential risk, according to NHS
documents.
Nuffield Orthopaedic Centre filed a "serious untoward incident"
report with the government's National Patient Safety Agency after
the fraught implementation at the hospital of a Care Records
Service for sharing electronic records nationwide.
Serious untoward incidents are investigated by the agency when
they have, or may have, caused death, serious injury, contributed
to a pattern of reduced standard of care, or caused serious
disruption to services.
Nuffield papers said the trust had identified "major issues of
patient safety" such as patients being "lost in the system". This
could involve patients being "lost" from waiting lists or not being
called in for treatment.
The installation of a Care Records Service at Nuffield has also
caused what the trust calls "major operational difficulties"
including a backlog of appointments and an inability to produce
both internal performance reports and those required by Whitehall.
These include some details on the size of the waiting lists and
cancellations. The trust insisted that patient safety had not been
affected.
Hospital executives said they had little choice but to go live
with the risky implementation of the system - although there had
been inadequate time for testing. The Care Records Service replaces
a patient administration system that was built in-house, and was
expected to fail completely in February 2006 due primarily to its
age and an overload of data.
The trust had been due to replace the old system in 2004 but its
procurement was halted by the advent of the NPfIT. Under the
national scheme, patient administration systems are bought
centrally under contracts with four local service providers.
Further delays occurred when Fujitsu, Nuffield's local service
provider, switched supplier from IDX to Cerner.
Nuffield finally went live on 20 December 2005, after what it
said was a "major effort by the trust and Fujitsu", even though in
the week before the switch significant amounts of testing as well
as the validation and migration of data were incomplete.
The new system is used in part to call patients into hospital,
and track inpatient and outpatient treatment. A report to
Nuffield's board on 6 March 2006 said there was a "significant
backlog of outpatient appointments" as a result of data migration
and other issues. This backlog and other problems arising from the
go-live were described as "critical issues" for the hospital.
In the paper to Nuffield's board, Jan Fowler, executive director
of nursing and operations and the trust's executive lead for
Connecting for Health, the agency which runs the NPfIT, said, "It
is likely that it will take the trust some months to address all of
the issues which have arisen as a consequence of the Care Records
Service system implementation."
Fujitsu won an £896m contract in January 2004 as part of the
£6.2bn worth of deals awarded under the NPfIT. Given the problems
at Nuffield, the hospital's audit committee said it wanted to know
who in the NHS was taking redress against Fujitsu.
After the go-live at Nuffield, staff reported that, "Major
configuration and software problems led to significant operational
disruption, and potential risk to patient safety, business
continuity, staff morale, and public and patient confidence."
The hospital's audit committee said Nuffield had a duty to
inform other trusts about its problems.
Fowler said that two days after going live, the system "went
down completely" due to a power outage at the datacentre and the
failure of the failover processes. This affected all radiology
information systems in the South of England, but at Nuffield
resulted in a "full working day without access to the system".
Since then there have been a "range of significant problems"
with the Care Records System and these have "caused major
operational difficulties".
Fowler said the problems were caused by "inadequate
configuration of the system for use at Nuffield, and a lack of
testing of that configuration, and resilience testing of the system
overall, due to the time constraints within the implementation
programme".
Supporters of the NPfIT have long feared that a disruptive
implementation at a hospital trust of a core component of the
programme could diminish enthusiasm for the programme nat-
ionally.
A spokesman for Connecting for Health said, "The Nuffield
Orthopaedic Centre (NOC) had an urgent need to replace an obsolete
and overloaded IT system. In response to the need, NHS Connecting
for Health, working with NOC, installed a new hospital-wide system
within some 12 weeks of signing the contract with suppliers. The
deployment has led to some issues which, regrettably, caused
inconvenience to patients and staff - though there has been no
adverse impact on patient safety.
"The trust, NHS Connecting for Health and Fujitsu, the local
service provider, are fully engaged in addressing the issues.
Intensive work by all parties has already resolved the vast
majority of issues raised and we fully expect the remaining small
number of concerns to be resolved in the near future.
"At the same time there have been successful deployments at NOC
of Picture Archiving and Communications Systems and Radiology
Information Systems. In the coming year there will be more than 20
such installations in the NHS Connecting for Health Southern
Cluster and we will ensure that lessons are learned from each
deployment."
The problem with the NPfIT