Hospital has long-term NPfIT problems, warns paper

An internal NHS document says that problems arising from the implementation of the Care Records Service at the A&E department of the Royal Free Hospital, Hampstead, could continue indefinitely.

The document “Lessons Learnt from the Royal Free Hospital Emergency Department”, refers to multiple problems and says there is a risk “the present situtation will continue indefinitely”. The document is a detailed assessment of the Care Records Service implementation at the Royal Free’s A&E department. The paper has been disclosed by an NHS employee and is focused on the problems, not any benefits arising from the implementation.

 Royal Free Hampstead NHS Trust was the first in the country to go-live, in June 2008, with the Cerner Millennium Release 1 Care Records Service as part of the National Programme for IT [NPfIT]. The London Cluster Release 1 system is compliant with the NPfIT “spine” and requires the use of smartcards. The Cerner R0 versions which were previously installed in London and the south of England do not require smartcards.

These are the main points of the paper which is the subject of an article in Computer Weekly and The Sunday Times today:

–  Problems which were expected to be sorted before go live or immediately afterwards were still not fixed three months later (when the report was written).
–  Long smartcard log-in times can waste clinical time or discourage clinicians from using the system
–  Long log-in times lead to smartcard sharing – this is a breach of protocol and can  cause difficulties identifying who has used the system
–  Poor user interface can make it difficult for users to choose clinically important tests
–  Reporting on the four-hour target is clunky and takes time to validate, leading to breaches or a serious risk of failures in meeting the government’s four-hour A&E target.
–  Data entered may not be visible to other [legitimate] users, or difficult to find
–  The system version of the hand-written Casualty Card [Cas Card] is not well designed which can led to the clinical risk of underestimating a patient’s condition
–  Regular system crashes present a clinical risk as patients can be lost in the system
–  Unfriendly user interfaces can make it difficult to investigate complaints from patients.
 – All information has to be written on paper – making key parts of the system redundant.
–  There is a risk of clerical time being wasted searching the spine unnecessarily
–  Fast registration of patients at A&E is not fast
–  There’s a risk of loss of data and some patients having no information recorded for them.
–  Problems occur when reporting deaths
 – The implementation of CRS at the Royal Free has been particularly difficult and has left the A&E department struggling to maintain the 4-hour target. Extra staff have been employed to minimise clinical risk.

A spokeswoman for the Royal Free said:

“Our new Care Records Service was installed in June this year. Although the implementation initially went better than we expected, there are some problems with the system which will still take some time to sort out. This is being pursued vigorously with the local service provider, BT, the London Programme for Information Technology and the system supplier, Cerner UK.

“The longest period of downtime we have experienced was overnight 17/18 September when an error occurred during a data back-up exercise at the BT data centre. This led to the trust’s computer system being unavailable from midnight on Wednesday 17 September for 11 hours. BT worked through the night to restore the service. During the downtime paper systems were used, which is the standard business continuity procedure.

“There are bound to be issues when installing a system of this complexity and these are being worked through. Some have required software or other solutions from BT/Cerner, while others have required the trust to find improved administrative processes. We expect that we will continue to experience issues from time to time in what are still early days for a change on this scale. Staff are particularly vigilant during any periods of disruption to ensure that patient safety is not compromised.”

A spokesman for BT, the NPfIT local service provider for London, said:

“We recognise that there have been problems at the Royal Free Hampstead NHS Trust, the first trust in London to implement the LC1 release of Cerner Millennium. There has been some downtime and we have worked in conjunction with the trust to keep this to a minimum.

“All parties – BT, the London Programme for IT and Cerner UK – are fully committed to working with the Royal Free Hampstead NHS Trust to resolve the remaining issues.

“BT and Cerner are working with the Trust and are taking a systematic and staged approach to dealing with the issues the Trust is experiencing.

“Service enhancements are being planned and will be implemented incrementally over the coming weeks.”


Patients “at risk” from flawed £12bn IT system – The Sunday Times, 5 October 2008

Long-term problems at pioneer Cerner smartcard site revealed in NHS document – Computer Weekly, 5 October 2008

Barts still struggling with CRS – E-Health Insider, 3 October 2008  

Foundation trusts tender outside the NPfIT – E-Health Insider, August 2008

Scheduling patients for clinics should be something hospital information systems do well – Health Perspectives blog

Labour’s unlucky 13 IT projects  – The Arch blog, October 2008  

NPfIT Cerner – a user writes – IT Projects blog, September 2008  

Channel 4 News – the NPfIT risks, February 2008