Duplicate patient records on Choose and Book, 200 "major incidents", and NPfIT secrecy

A team of people is working to stop medical information going missing after a software upgrade under the NHS’s IT Programme led to hundreds of unwanted, incorrect and duplicate patient records being created every day.

The problem involves NHS sites in Greater Manchester and raises questions about how well some systems are being tested before going live as part the £12.4bn National Programme for IT [NPfIT].

Internal documents show that the duplicate patient records are incorrect. They have been created on the assumption that patients do not already have a record – even if they do. If these duplicates are left in place it could lead to clinicians seeing patients without access to important medical history.

To stop this happening, patent records have to merged with the duplicates quickly. If a backlog of unmerged records builds, hospital record libraries could send to clinics, days in advance of an appointment, the wrong patient file based on the duplicate record – which could be that of an entirely new patient.

The internal documents also warn that the merging of duplicates with the main record will create significant additional work, and could cause confusion later.

This is because the merged record may have to be unscrambled later so that the different identification details and numbers – which are retained when the duplicates and main record are brought together – do not confuse patient administration systems.

The problem has arisen after a software upgrade, Maintenance Release 1 of the iPM patient administration system supplied by NPfIT local service provider CSC and its subcontractor iSoft.

The upgrade over the weekend of 21/22 April 2007 led to up to 400 duplicate records being created each day for patients who had hospital appointments arranged as part of the NPfIT Choose and Book system.

The incident comes at a time when some staff at one of the hospitals affected, University Hospital South Manchester Foundation Trust, are already having to cope with a long list of Choose and Book work-arounds – manual or semi-manual ways of avoiding software bugs or problems waiting to be fixed in iPM or Choose and Book.

Computer Weekly has received other internal documents that show the incident in Greater Manchester is not isolated. There have been about 200 “major incidents” at hospitals across England in the four months to the end of January 2007.

Dozens are in the highest “severity one” classification and some of these incidents have affected NHS sites across England. Failures include PACS digital x-ray equipment and radiology information systems.

Connecting for Health refuses to publish details of major incidents but says the number is decreasing.

Last month Lord Hunt, the health minister, dismissed a report of the Public Accounts Committee that was highly critical of the NPfIT. Lord Hunt said the committee’s report was based on one published by the National Audit Office that was “out of date”.

But the incidents mentioned in the internal documents happened after the report of the National Audit Office in June 2006.

The Health Committee of the House of Commons began its inquiry into aspects of the NPfIT on 26 April 2007 but its narrow terms of reference exclude looking into the threats to healthcare of troubled NPfIT go-lives.

In a joint statement Connecting for Health and CSC said:

“A scheduled upgrade to the latest version of the iPM Patient Administration System was undertaken for all organisations in Greater Manchester using the iPM system solution during the weekend of 21st/22nd April. This includes University Hospital South Manchester Foundation Trust and PCT Clinical Assessment Centres who all currently make extensive use of the Choose and Book system to refer patients to clinical assessment services and outpatient clinics.

“This was the latest in an ongoing programme of upgrades successfully introduced by CSC since the beginning of April. Although comprehensive testing is undertaken prior to the upgrades taking place, it is not unusual for these kinds of upgrades to identify teething problems in the early stages following implementation.

“In this particular upgrade a problem has subsequently occurred with the integration of this Patient Administration System and the Choose and Book system for users in Greater Manchester, which has led to some duplicate patient records being created. We estimate that around 400 duplicate patient records might have been created each day. However, the system is being continually monitored throughout each day and where a duplicate is identified data is being merged to form one single record for each patient.

“To put this in context, in an average day across Greater Manchester, the CSC Alliance processes 15 transactions per second which equates to 1,296,000 transactions across all Patient Administration Systems per day in Greater Manchester. There are over 3.5 million patients in Greater Manchester.

“Local Service Provider (LSP) CSC has identified the root cause of the problem and is developing a permanent fix. The fix will be applied to all users in Greater Manchester who received the recent upgrade as soon as it is available in the next 2-3 weeks. Prior to the application of the permanent fix, an interim solution has been put in place to identify the duplicate records and correct them. This has now been put in place with the full agreement of those organisations affected and will have minimal impact on the users of the system and no impact on the delivery of patient care.”

Related articles:

1) National press follows up Computer Weekly’s article on National Programme for IT incidents

2) Duplicate patient records in Manchester – the risks and how it happened

3) Is government trying to control information on problems after NPfIT go- lives?

4) Some examples of “Major Incidents“.

5) Connecting for Health attacks NHS users over reporting of major incidents