NHS trusts have deferred plans to go-live this year with electronic record systems under the £12.7bn National Programme for IT [NPfIT].
The deferral of major roll-outs of the Care Records Service comes after calamitous introductions of the system at hospitals in London and the south of England.
Some observers will see the halting of e-record plans as a further sign of the slow demise of the NPfIT. But officials at NHS Connecting for Health, which runs part of the NPfIT, see the delays as a chance to understand thoroughly what has gone wrong at trusts which have implemented the Care Records Service.
NHS Connecting for Health insists that trusts in London have not postponed go-lives indefinitely. A spokesman said: “Meetings will be taking place over the next couple of weeks with the London trusts to discuss the implementation dates and NHS London and those trusts hope to have revised dates as soon as possible.”
The cancellations of plans have added millions of pounds in extra costs for trusts which have recruited NPfIT specialists and trained thousands of NHS staff for go-lives which have not happened.
Freedom of Information Act disclosures
Documents obtained by Computer Weekly under the Freedom of Information Act give an insight into some of the extra costs, problems and risks which face NHS trusts whose boards have taken decisions to become an “early adopter” of the Care Records Service.
St Mary’s Hospital in London, which is part of Imperial College Healthcare NHS Trust, has released the documents. It was due to become an early adopter of the problematic Cerner “Millennium” system which has been installed at Barts and The London, and the Royal Free Hospital, Hampstead.
St Mary’s has cancelled several go-live dates this year, the latest in August 2008. It is among several NHS trusts that have delayed plans to implement the Care Records Service until next year at the earliest. No major implementations under the NPfIT are expected this year, contrary to undertakings given to Parliament by NPfIT minister Ben Bradshaw.
Go-live presented “huge risks”
The documents released under the Freedom of Information Act say that senior executives at St Mary’s in Paddington regarded an implementation under the NPfIT as carrying “huge risks”.
The “private” minutes of a St Mary’s executive meeting said:
“There were huge risks to implementation as experienced in other trusts such as Barts and The London and The Royal Free… the situation [when to go-live] was being dealt with on a day to day basis. The delay would mean that the project costs were likely to exceed the budget by £1m with the actual amount depending on the new date.”
The papers highlight the difficulties of producing comprehensive statutory reports from the system. They describe this as “one of the Care Records Service showstoppers”. There was also concern about the possibility of a go-live having an undue effect on the health and care of patients. For example there was a risk that a failed merger of tens of thousands of duplicate files could end up with the wrong records being given to clinicians when they came to see patients.
St Mary’s Paddington pioneered the use of robotics in keyhole surgery. It’s also famous because its staff delivered William and Harry, the children of Princess Diana. A successful go-live there would have been an important boost for the morale of those working on the NPfIT. But the hospital faced multiple problems, including concerns among doctors about what they saw as a lack of clinical functionality in the London “LC1” version of the Cerner system.
A “lot of people needed” for go-live – but no budget
The minutes of programme board minutes also said that “a lot of people would be needed around the time of implementation but “there is nothing in the budget for extra resources”.
Go-live would mean scaling back the number of patients the hospital treats in its clinics – by up to quarter in the first week after go-live and 10% to 15% in the second week. Anyone who failed to bring their smartcard with them, or did not have one, would “not be able to work”. And some clinicians did not “really understand” the Cerner system.
Costs much higher than predicted in business case
The FOI documents also show that the trust’s business case for the CRS has been overtaken by events. St Mary’s business case for the Care Records Service in 2007 said that the system would go live in February 2008 and by the end of 2008/9 would yield cash-releasing savings of £327,000, rising to total savings of £5m by 2014. In fact the CRS hasn’t gone live so there are no savings yet – and costs are much higher than expected.
In the business case, the total CRS costs to the end of the financial year 2014 were put at £1.9m, But the trust has already put aside £1.5m for CRS and expects to find a total £2.8m from the ICT budget.
The trust’s FOI papers say: “Some cash releasing savings will take longer than originally envisaged in the business case and the business case needs to be revised.”
Main risks of go-live
St Mary’s listed the main risks of going live with the Cerner system. “The key risks as a result of the implementation [of the LC1 Cerner Millennium Care Records Service] were further cost overrun, disruption around the go-live date and beyond, loss of income and loss of management and clinical visibility.”
After the go-live in February 2008 was cancelled, the trust set a new date of July 2008, then August. Its spokeswoman told Computer Weekly it has set no new date.
Impressive CRS programme teams – but no go-live
Meanwhile the trust has set up an impressive CRS programme structure – a programme board, a clinical advisory group, a design authority, a programme director, programme manager, programme team, and other teams to manage projects, change, benefits, systems, data migration, communications, medical records, infrastructure, and training and security. It has also appointed project managers and project officers.
What NHS CfH says:
In response to media reports that the e-records part of the NPfIT has been halted, NHS Connecting for Health said:
“Many elements of the National Programme for IT are advancing and some are complete. The Programme is one of the largest IT change programmes in the world and it is inevitable that such transformation will present challenges. We are working with the NHS and our suppliers to ensure that systems are implemented as smoothly as possible. It is clear that patients and clinicians are now beginning to see the potential benefits these systems bring to improve patient care.”
On delays to the go-live of the Lorenzo system which is due to be installed by CSC at trusts in England except in the south and London, NHS Connecting for Health said:
“CSC, NHS Connecting for Health, the relevant strategic health authorities and the Trusts themselves are working together in a strong collaboration to ensure that the system goes live at all three early adopter sites (Morecambe Bay, Bradford and South Birmingham).
“As expected, deployment testing is identifying technical issues which are being resolved on an ongoing basis. Collectively, the early adopter trusts, SHAs, NHS CFH and CSC recognise the need to achieve the necessary quality criteria for go-live and view this as more important than a particular date.”
On delays in London, the CfH spokesman said:
“NHS CFH supports NHS London, London Programme for IT and BT in their decision to take stock of current implementations at London trusts. We agree that learning from those experiences is an important next step in successfully introducing information systems to support patient care across acute settings.”
An NHS London spokesperson said:
“The NHS in London is working hard to deliver an electronic care records service, called Cerner Millennium, which will help provide better care for patients.
“Versions of this are now up and running in four hospitals trusts. However, as is common in programmes of this size and given the complex and sometimes unique operational demands of London’s hospitals, these implementations have given rise to a number of challenges.
“Following the latest stock-take of progress, the decision was taken with BT to concentrate on quickly resolving the remaining issues facing the live trusts whilst continuing with plans for future deployments for which revised dates will be agreed.
“This prioritisation will mean more focus can be given to the need for greater localisation of the system based on many factors including different local workflows and clinical practices. It will also mean a more effective use of BT, Cerner and NHS resource.
“This approach will also give those trusts currently planning deployments – Kingston and Queen Mary’s Roehampton, St George’s and Imperial – more time to plan and prepare for an implementation which will benefit from the experience of the earlier deployments.
“The deployments in mental health and community systems and for digital imaging across London continue to progress well.”
Connecting for Health 12-week forecast – CfH document
More delays to NPfIT – UK hotviews
Big problems hit Cerner care records service rollout – Computer Weekly, Aug 2008
St Mary’s delays go-live – E-Health Insider, Aug 2008
Fawlty Towers – Connecting for Health grinds to a halt, NHS, behind the headlines blog
E-records has ground to a halt – Daily Telegraph, October 2008
Future of NPfIT in doubt – Daily Mail, October 2008
Patient data leaves the NHS – US website