CSC, the main supplier of the National Programme for IT [NPfIT], has confirmed that it is considering offering alternative software to NHS trusts ahead of the clinical functionality being planned for its "Lorenzo" system.
The change of plan will surprise board directors at NHS trusts in the North, Midlands and East who have been waiting for several years for the Lorenzo Care Records Service system from CSC.
Since £6.2bn worth of contracts were signed with local service providers in late 2003 and January 2004, Lorenzo has been at the heart of plans by NHS Connecting for Health - which runs much of the NPfIT - to roll out an electronic health record for 30 million people in all areas of England except London and the south where the "Cerner" Millennium is due to be installed. Lorenzo was being developed by iSoft [now IBA Health] to be deployed by CSC to acute, mental and primary care trusts.
If CSC decides to offer the "Alert" system from a Portuguese healthcare specialist, it could mean that dozens of boards of NHS trusts alter plans dating back years to install Lorenzo.
But it is unclear how quickly the Alert system could be adapted to the UK market - and in particular how quickly it can be subsumed into the plans of NHS Connecting for Health for integrated healthcare systems. Lorenzo was originally expected to be available in 2004.
And it has proved difficult to adapt the US "Cerner" system - which is being offered to NHS trusts in London and the south of England - for use in NHS trusts.
Last week Computer Weekly and The Guardian revealed that a confidential internal report had revealed hundreds of issues in the first release of Lorenzo. CSC executives had hoped that Lorenzo would begin to be rolled out to the NHS this month but it has been delayed until next month at the earliest.
The first release, however, has only limited use for clinicians. The main Lorenzo patient administration system is Release 2 which Health Minister Ben Bradshaw said would be ready for deployment this Autumn.
But Computer Weekly has learned that Release 2 has a "red" status at its stage of development, and may not go live at any NHS trust this year.
At the "Alert" stand at HC2008 Healthcare Computing conference at Harrogate this year, CSC staff were demonstrating the Alert system. Alert offers a range of healthcare products which it says will lead to the "paperless hospital".
At a hearing of the Public Accounts Committee last week [16 June 2008] a senior civil servant at the Department of Health was questioned about the Alert system by Conservative MP Richard Bacon. The civil servant drew attention only to the e-prescribing features of Alert.
This was the exchange:
Richard Bacon: "Can you explain why if you are so confident that Lorenzo will eventually get sorted and delivered, why CSC is hawking a Portuguese software system around?"
Civil servant: "I am not aware they are hawking this Portuguese software system around."
Bacon: Aren't you? CSC were on a stand selling or offering the Alert system from Epsom, a Portuguese supplier, at the Harrogate IT conference. You [Connecting for Health] had a stand there yourselves? They are in negotiations with Epsom and St Helier trust right now, which is an iSoft customer. Why would they do that if they have confidence in Lorenzo?"
Civil servant: "I am aware that the Alert system is a very good e-prescribing system which can be adopted as an interim system by a trust if they are on a later path for taking Lorenzo. So there is a very legitimate reason why a trust might want to take the Alert e-prescribing element of their system."
Alert's website says it offers among other products integrated electronic health record systems, and those covering scheduling, waiting rooms, accident and emergency departments, operating room episodes, outpatients and physiotherapy.
Its systems summarize for each patient, side by side with all documentation material, all pending tasks on medications, laboratory exams, imaging exams, and procedures. The company's literature adds that doctors can see from a patient's health record the perceived problems, pending examinations from previous encounters, reports from previous episodes, and other information.
The system also sends alerts to doctors and nurses if the medication prescribed has not been administered yet, the patient has not been attended to for a set number of minutes, whether there are new laboratory results waiting, a report from an imaging examination or whether someone is trying to transfer a patient to them.
And Alert has already been appointed a supplier to the NPfIT, for clinical information technology services, under the Additional Supply Capability and Capacity [ASCC] "framework" contract.
Alert applied to 27 of the 37 ASCC service categories and says it was successfully appointed to all, which means it is qualified to participate in further public tenders by NHS organisations and other NHS-funded organisations for a wide range of IT systems and services. ASCC lasts at least four years.
When Alert was chosen for the ASCC the CEO of Alert Jorge Guimarães said, "This achievement shows our commitment towards the UK market. We presented an integrated solution which goes far beyond mere IT provision and we look forward to contributing to the success of the NHS National Programme for IT."
A spokesman NHS Connecting for Health drew attention only to Alert's e-prescribing features. A CSC spokesman said:
'Under the framework of ASCC, CSC and Alert have agreed to look at whether there are opportunities using Alert's applications to deliver clinical functionality to the NHS ahead of Lorenzo making it available.
"The Alert system is not a comparable system to the full Lorenzo Regional Care Solution. CSC, as you would expect, regularly reviews and evaluates new solutions within its healthcare business and currently works with several other providers for specialist applications for the NHS."
CSC's interest in Alert becomes understandable when it's considered in the context of concerns expressed by the National Audit Office in its report on the NPfIT. These are some of the points made by the NAO report in May 2008 on Lorenzo:
"Current indications are that it is likely to take some four years more than planned - until 2014-15 - before every NHS Trust has fully deployed the care records systems. Until Lorenzo is available and has started to be deployed, there remains a particular uncertainty over timing in the North, Midlands and East..."
"...In the North, Midlands and East to date only interim systems have been deployed as Lorenzo is not yet available."
"The development of Lorenzo has taken much longer than originally planned, with the delays attributed in part to an underestimation by all parties of the scale and complexity involved in building a new system from scratch."
"In the light of concerns about progress in developing Lorenzo, in summer 2007 NHS Connecting for Health and CSC jointly commissioned two reviews of the delivery arrangements. The first review, by experts in IT development, identified, among other things, a lack of clarity around responsibilities and shortcomings in programme management and end-to-end delivery arrangements within CSC and iSOFT. It concluded that further delays could be expected. The second review, by a large-scale systems integrator, reached similar conclusions, in particular noting that the then current plan for development and deployment was behind schedule and in any event not feasible, and recommended that the phased strategy that NHS Connecting for Health had suggested should be adopted."
"... the planned two releases of Lorenzo have been broken down into four smaller releases. Nevertheless there remains considerable uncertainty over the delivery schedule for Lorenzo."
"The delays in developing Lorenzo make it even more important to get the product right and win the confidence of NHS staff. Current plans are to have the first release available for deployment at three early adopter Trusts in summer 2008, with full roll-out planned from autumn 2008. Given the experience of deploying other care records systems within the Programme, however, this timeframe may prove over-ambitious."
It has taken years to get to adapt the Cerner system to the UK NPfIT market and it still needs more work. Would it take years more for a Portuguese system to be adapted for use in the NPfIT in England? Perhaps the Alert system will be just what CSC and the NHS need. On the other hand a change to Alert could be seen in the context of NPfIT delays as another extreme movement of the thrashing tail of a grounded whale.