NPfIT executives will stand by Lorenzo

Richard Jeavons, senior responsible owner for service implementation on the NHS National Programme for IT – NPfIT – has affirmed his team’s commitment to the “Lorenzo” product from suppliers CSC and IBA Health

He has indicated that his team will stand by the product whatever happens.


Lorenzo is one of the main products within NPfIT. It is being developed by suppliers CSC and IBA Health for NHS trusts across England, except in London and the south where the main strategic NPfIT software product is Cerner’s “Millennium” system.

At a press conference at the headquarters of the Department of Health in Whitehall last week [13 March 2008] Jeavons was asked whether those running the NPfIT will ever reach the point, if the delivery dates for Lorenzo continue to slip, they will accept the product is never going to work satisfactorily across the NHS.

It was an important question because some NHS trusts have been planning, re-planning and planning again NPfIT implementations on the basis of a strategic software product that has been promised since 2004 but not yet delivered.

This was the question to Jeavons: “Would there ever come a point where you say: that’s it; we have had enough; we are going to do something else?”

Jeavons replied:

“I doubt it. When I think about that sort of question I put myself back there running a trust [Jeavons is a former chief executive of West Yorkshire Strategic Health Authority] thinking: ‘I have a lot of responsibilities; I rely entirely on my basic information systems … I am facing quite a long strategic horizon in terms of information system development. There is the national programme with some quite long-term goals and I have short-term urgent business needs. How am I going to balance that?

“You have to achieve a balance. You have to do things because they need to be done immediately and you have to keep your eye on long-term, strategic goals. It’s exactly the same with this programme… We have to hold to that strategic goal and the means to achieve it.”

A basic version of Lorenzo is expected in the next few months. But health experts are unsure whether release 2 – a patient administration system – will be delivered later this year as promised. Release 3 is due in 2009 and release 4 in 2010.

Without a fully-functioning Lorenzo many trusts are relying on the ageing iPM patient administration system supplied by iSoft (now IBA Health). Northamptonshire Teaching Primary Care Trust reported in January 2008 that there were “serious connection problems and ongoing issues with the iPM PAS”. It added that CSC has agreed to produce a service improvement plan. “The board agreed issues where the national programme support is not meeting expectations need to be escalated to SHA and CfH”. The trust planned to escalate issues.

And it has been reported by Yorkshire and the Humber Strategic Health Authority in February 2008 that:

“Problems are still being experienced with the Local Service Provider’s interim PAS [patient administration system] and Order Communications systems, although only five of 22 Yorkshire and the Humber Trusts are using such systems…

“The development of Lorenzo is particularly important to Yorkshire and the Humber Trusts, most of whom have a pressing need for the replacement of their core Hospital systems, which are to take place over the next 3-4 years. Demonstrations of Release 1 [of Lorenzo] have been well received by Trusts and progress reports on the development of R2 are encouraging.”

Separately, Warwickshire Primary Care Trust is said in an NHS trust board paper to have considered that “waiting for Lorenzo to deliver the full solution” was “not desirable and that an interim solution should be considered”.

South Warwickshire General Hospitals NHS Trust says that the version of Lorenzo it is seeking is “due to be released at the earliest in 2012”.

My comment:

Pragmatism requires that there should be a cut-off point beyond which the Department of Health and NHS trusts should have to wait no more. The private sector doesn’t usually have the luxury of time and funding to wait indefinitely for a product that’s impressive on paper and in small-scale demonstrations. The promised strategic product is more than three years late. Will six years still be acceptable?

One trust says it has been told by its strategic health authority that it doesn’t need to install Lorenzo. It can simply carry on upgrading the iPM systems it has now. This is a political fudge. How long can trusts rely on “interim” systems based on old technology?

At some point trusts will have to decide what they’ll install to replace old technology. And if a fully-functioning version of Lorenzo is still not available there may be more interim systems proposed – which is not going to give the NHS the modern technology, the new ways of working, and the new standards of care and treatment of patients which has been promised by ministers in their announcements about the £2.3bn, £6.2bn and later the £12.4bn National Programme for IT.

**

Lorenzo (codenamed Penfield) – when due to be available to NHS trust early adopters:

Release 1 …….1 March 2008 – 31 May 2008

Release 2 …….1 Oct 2008 – 30 Nov 2008 [patient administration system]

Release 3 …….1 July 2009

Release 4 …….1 March 2010

(Dates based on official information as of February 2008)

Release 1 is due to be deployed over legacy patient administration systems. It’s due to support the ordering of tests and reporting of results for pathology and radiology, and the ordering of patient-based services such as physiotherapy, occupational therapy and nursing interventions.

Release 2 is due to replace legacy patient administration systems. It is due to provide support for managing referrals, waiting lists, scheduling, out-patient, in-patient and day-care case loads, care planning, case note tracking and contract management. It’s also due to provide support to trusts that need to record Mental Health Act administration details and undertake mental health reviews and tribunals.

Release 3 is due to provide support for prescribing and administering medication, maternity and theatre management.

Release 4 should provide support to GP practices and for health screening, integrated care pathways, commissioning, and stock management. It is also due to provide facilities to enable a linking to remote devices to facilitate telemetry, and for working when disconnected from a network.

**

PS The dates given above already appear to have slipped (since February 2008). Ben Bradshaw, the health minister, told the House of Commons on 12 March that the first release of Lorenzo is due “from June 2008”. The use of the word “from” means, of course, that there is now no date by which the first release is due to be delivered.

Links:

IBA Health’s CEO comments on Lorenzo and the NPfIT

CfH chief says Lorenzo will come

Late delivery of iPM software maintenance upgrades hits trusts across the North West

NHS records system delays cost CSC £5m

£82m in payments to striken iSoft

NHS computer chaos deepens – Richard Bacon MP

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"Release 4 should provide support to GP practices"

It is worse than that.

According to a powerpoint presentation at an EoE NPfIT event in December 2007, phase 4 is an integrated EPR with the current CSC/TPP SystmOne fully integrated. i.e. Lorenzo will **replace** the GP system.

I have not been able to find anyone who has considered the risks involved, or the clinical governance of the SSEPR (Single Shared EPR).

In SystmOne, diagnoses and prescriptions may be entered by any organisation using the record - GP, Community, chiropody, *anyone*, and can only be altered by someone in the organisation making the entry.

I don't think that patients ought to have diagnoses which are not true put into their records - as has already happened in SystmOne. Known erroneous recorded diagnoses include diabetes and multiple sclerosis.

It would appear that the introduction of Lorenzo is designed to destroy the GP EPR in NME.

GP electronic records are one of the major successes in IT in the NHS: we have gone from paper records to being able to cope with the Quality and Outcome Framework (QOF) and QMAS: why plan to destroy all this good - and mission critical - work now?

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