Cerner success at Kingston Hospital?

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Kingston Hospital reports that its implementation of the Cerner Care Records Service  has been more successful than at other trusts - but the local paper, the Surrey Comet, isn't convinced.

Meanwhile the hospital's Chief Executive reports that "ongoing operational issues are being prioritised".

In 2009/10 the Trust received extra money - through NHS London and NHS Connecting for Health - to support its Care Records Service go live and to help develop a scaleable national implementation model. But it needs extra funding because "ongoing resource requirements are much greater than those originally expected".

The Trust says: "Due to increased development of the reporting systems to ensure they are sophisticated enough to deliver a timely, accurate reporting solution, the Trust is currently seeking additional funds to ensure successful delivery."

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After learning the lessons from NPfIT go-live failures at various hospitals, Kingston Hospital went live with the Cerner Millennium Care Records Service on 30 November 2009.

E-health insider reported that trust switched from its iSoft CliniCom Patient Administration System to Cerner.

Katie Grimes Kingston's chief executive, said at the time: "The escalation process, with the different layers of support, seems to be working. Our CRS [Care Records Service] Command Centre is a hive of activity with the teams there solving minor technical glitches with the transfer of data between our old PAS and CRS.

"Many of the issues are simply the nerves of the first few hours of using the system, which is exactly what we predicted and planned for."

An NPfIT CRS success?

Now it transpires that Kingston is encountering teething problems. It has put in place a remedial plan to "ensure that accurate information could be obtained on key targets such as the 18 week wait".

The Trust says it met the 18 week target for December 2009 but "it was possible that the target might be missed in January 2010" - which raises the question of whether any patients who were not seen within 18 weeks have ended up as possible victims of Kingston's CRS success.

The Trust has conceded that outpatient DNAs [did not attend] increased in December and January "due to post CRS implementation issues".

Kingston spends £800,000 on "floorwalkers"

A long-established media group in Surrey, the Surrey Comet, reports that the trust has "been forced to spend £800,000 for IT support 'floorwalkers' as NHS staff struggle to come to grips with a troubled computerised records system".

The trust says the implementation has been a success. The chairman of the hospital, Christopher Smallwood, told the Surrey Comet,

"Although there have been some rough edges, this has been the most successful introduction of CRS."

And Grimes said:

"I think we have got all the key issues on to the table. More clinicians are beginning to see the benefits of deployment of the system."

Some other parts of the Surrey Comet article:

"Delays in implementing the £12.7bn national Care Records Service (CRS) cost Kingston £500,000 last summer in contractors and staff kept on the payroll in readiness for its introduction.

"The overall cost of teething problems in the new system so far is more than £1.2m, although the trust said it had made some of the money back.

"Floorwalkers roam around providing IT support for frustrated workers trying to input information into the system.

 "The number of calls to the help desk has dropped to about 50-a-day, with training for staff who have problems using it."

Kingston's February 2010 board minutes

Below's excerpts from Kingston's board minutes will be proof to some of the success of the implementation.

Others may see the minutes as defensive of Cerner, which is the chosen software of BT, the local service provider for London, and NHS Connecting for Health, which runs parts of the NPfIT.

Defensive of Cerner?

Minutes at Barts and The London were defensive of Cerner: when there were CRS problems Barts pointed out they had little or nothing to do with Cerner; and Kingston says: "A number of the issues related to cultural and process changes required within the organisation rather than issues directly related to the performance of CRS."

Excerpts from Kingston's February minutes:
 
CRS

"The CRS implementation had been more successful than at other Trusts. However, a number of data migration issues had emerged which had had operational implications, particularly in outpatients.

"A structured programme was being put into place to address outstanding issues. Those issues that had a direct impact on patients were being prioritised.

"A number of the issues related to cultural and process changes required within the organisation rather than issues directly related to the performance of CRS.

"As yet it was unclear whether the Trust would be able to address all of these issues by the end of February 2010.

"A remedial plan had been put in place to ensure that accurate information could be obtained on key targets such as the 18 week wait. The Trust had met the 18 week target for December 2009 but it was possible that the target might be missed in January 2010."

The Board congratulated the IT director and "all the Trust staff who had been involved in the implementation of CRS, particularly those in operations and IT".

The stabilisation of CRS at Kingston continues

The Hospital's Chief Executive reports:

"The stabilisation of CRS continues with a refocused programme of work.

"Ongoing operational issues are being prioritised within relevant workstreams and being actioned accordingly. A dedicated email address and telephone and fax line have been set up for GPs who are experiencing CRS related issues to enable speedier resolution."

Key financial risks are CRS and data challenges
 
Separately in its February papers the Trust reports:

"The year-end forecast remains a surplus of £1.9m before impairment with the main risk still being CRS implementation and data challenges..."

"The Trust successfully deployed a new patient administration system in late 2009 - the Cerner Millennium Care Records Service (CRS) as part of the National Programme for IT.

A CRS benefit: real-time bed management

"As CRS beds in, it will be possible to reduce the complement of additional staff that have been required to enable go live and to seek further operational synergies - for example through real time bed management.

"Little recognition of the potential savings has been made in the plans to date as this is still considered premature."

Comment:

The Cerner implementation at Kingston appears to have gone better than the go-lives at some other hospitals.. But it's early days - and it seems that some patients might have noticed the disruption, however diligent were the attempts to minimise it. 

Links:

Hospital spends £800k on IT troubleshooters - Surrey Comet

Minister to sew up new NPfIT deals ahead of general election? - IT Projects Blog

O'Brien claims govt may lock-in NPfIT - E-Health Insider

Kingston goes live - NHS London - London Programme for IT

Tories uncomfortable on what they'll do about the NPfIT - IT Projects Blog

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