When a group of pioneering hospitals in London went live with
a major e-records system under the government's £12.7bn NHS IT
scheme, aheadline in The Sunset the scene for the next 18
months.
"
Data Woe at 2 London Hospitals," it said, pointing out that
doctors had been forced to write notes on slips of paper when a new
Care Records Service system crashed.
Barts and The London NHS Trust and BT, the main IT contractor
for London under the National Programme for IT (NPfIT),
denied the story.
The trust said, "The new patient administration system - also
known as the Care Record Service (CRS) - did not crash A period of
adjustment was anticipated with contingencies in place to support
staff who experienced any problems, with the majority of issues
being resolved within 24 hours."
The statement proved optimistic. Difficulties at the trust have
escalated, almost month by month, since the Care Records Service
system went live in April last year.
Backlogs of patients who were not seen or treated within
government waiting-time standards grew at first to hundreds.
Now, 18 months after the go-live,
Computer Weekly has revealed that at least 14,000 patients are
on a backlog for treatment. Barts has lost track of their
appointments - though the system was installed to keep track of the
healthcare "pathways" of patients.
No one should wait more than 18 weeks for treatment after being
referred by a GP, under government guidelines. But hospital
executives have no idea how many of the 14,000 patients are outside
of the 18-week limit.
Doctors at the hospital made electronic requests for their
patients to be treated, but found much later, or never discovered
at all, that the appointments had not been made. Doctors or their
staff pressed the wrong keys, or the requests did not end up at the
expected destination, or both.
Data already in the system was inaccurate and some doctors found
the technology was not always simple to use, or did what they
expected. Most worryingly, nobody seems clear on what has caused
the chaos.
Since August things have got a little better. The 18-week
backlog has come down from 26,640 to about 22,000. Some of the
22,000 on the list comprise duplicate records, but at least 14,000
are thought to represent actual patients.
The trust's board hopes things will be back to normal by
December. But the trust has been hoping since April 2008 that a
return to normality was around the corner.
It is difficult not to feel sympathy for Barts' IT specialists,
doctors and administrative staff. The decision to go live was taken
at a higher level, amid a ministerial imperative for the NHS to
show that the NPfIT was delivering.
London officials wanted to show that the capital could deliver.
But they may have fallen victim to the
"irrational exuberance" which afflicts large IT projects.
Today the political pressure for the NHS to install the Cerner
Millennium Care Records Service throughout London is as strong as
ever. Ministers and officials hope that a succession of successful
launches will throw a warm light over the NPfIT.
The Care Records Service programme is running
four to five years behind schedule, according to the Public
Accounts Committee.
Ministers want to catch up. So officials in London have
announced plans to
resume a roll out of the Cerner system. They say that the
lessons from Barts and other sites have been learnt.
But going live elsewhere before anything has been published on
what exactly has caused the problems at Barts may be a further
demonstration of unwarranted optimism.
Ross Anderson, professor in security engineering at the
University of Cambridge, said, "Hospital managers have good reason
to ask why they are ordered to put in systems that are not fit for
purpose and are then punished for not meeting targets when there
has been a balls-up."
Politics has plunged some hospitals, particularly Barts, into
administrative and operational turmoil in the name of the NPfIT. It
will be a pity for patients if politics continues to dictate the
roll out of the programme.
Next roll out
The next hospital due to go live with theCerner Care Records Service is Kingston Hospital NHS
Trust.
Another London hospital, the
Royal Free at Hampstead, which went live with LC1, a
Spine-compliant version of the Cerner Care Records Service, is
struggling to keep track of patient appointments - and it launched
the system as long ago as June 2008.