Some lessons from troubled go-live of NHS Care Records at Buckinghamshire Hospitals NHS Trust

The lessons (below) expand on an article published in Computer Weekly this week [24 April 2007] and a related piece on this blog.

This is a summary of the lessons from a go-live of the Care Records Service at Buckinghamshire Hospitals NHS Trust:

– Although administration staff are getting used to the system, it does sometime seem to take longer to do the same event than before.

– The increased functionality creates an environment in which it is easier to make mistakes than the more limited old systems

– Future deployments are being re-planned to reflect the learning to date.


– All Trusts need to provide reports on areas such as inpatient, outpatient, day case activity, etc. to our funding Primary Care Trust. In addition, we can use this information to monitor and learn from our own performance… [There have been] some difficulties in completing some aspects of reporting, caused by a combination of data migration issues from old systems, adherence to defined processes, training and the flexibility that exists within the Cerner system that enables short-cuts to be taken.

– The data and reporting area suffered the largest number of issues at the beginning, and although the majority of the issues have been resolved, work continues on some significant issues, with solutions being delivered more slowly than we had hoped .

– A reporting taskforce has been set up, consisting of experts from the NHS, NHS Connecting for Health, Fujitsu and Cerner. The aim of this group is to fully ascertain where there are still reporting issues and close them down, not just by the use of tactical arrangements (which they have already developed for use in the short term) but by fully understanding the root cause and by making robust changes to ensure that this is fully mapped, understood and resolved.

**

The extracts above are from a letter to us from Anne Eden, Chief Executive, Buckinghamshire Hospitals NHS Trust. She is based at Amersham Hospital.

Her letter is a response to our request under the Freedom of Information Act for minutes of meetings on the Care Records Service, the main part of the NHS’s National Programme for IT.

Her trust refused to supply the minutes saying it was too costly – a point made by other trusts when we applied to them also for details of their pioneering work on the Care Records Service. Their refusal is not surprising given the desire of Whitehall to control information on the NPfIT. But the reason cited for the refusal is of questionable legality, which will be explored on this blog soon.

Eden did, however, write a long and useful letter to Computer Weekly on the lessons from her trust’s go live in late 2006 of the Care Records Service. The letter is below.

Letter from Anne Eden, Chief Executive of Buckinghamshire Hospitals NHS Trust, to Computer Weekly:

“I do not wish to be unhelpful and have therefore put together a statement on lessons learned which is what I presume you were seeking in the request for papers. I do hope this meets the spirit of your Freedom of Information request.

“As you are aware, we are part of a much bigger picture as the systems are being delivered by NHS Connecting for Health, which is the Department of Health agency responsible for delivering the National Programme for IT.

“In the south of the country, Trusts will be using a computer system known as ‘Millennium’, which is developed by an American company, the Cerner Corporation. They in turn are working with the main contractor for the south of England, Fujitsu, which oversees the delivery of the system across the south.

“Cerner Millennium is one of the most modern computer systems offering support for clinical care. It is being released in incremental stages, building up increased “functionality” in stages. That is completely in line with best practice in IT implementation. The version that went live in south Buckinghamshire recently is known as Release 0 or R0.

“A lot of effort has been put in both by the NHS and Fujitsu to remedy any problems that are identified after a Trust switches on its new system, but we could not realistically anticipate an IT project of this size to go without any unexpected glitches and it would be naïve for anyone to do so.

“The objective of the new systems in our Trust, and indeed across the whole of the south of England, is to provide greater resilience and far better availability of service than was typically available with previous NHS IT systems, although it will take time to achieve this objective.

“The potential for this system is of course quite high as ultimately it can be expanded to allow doctors to handle most transactions and orders from their desktop. As I have said, we are part of a much larger programme. As a result we are able to benefit not just from the lessons learned within our own organisation, but from those who are implementing the systems within the whole southern region.

“In addition, the three sites (including our own) that have switched on the system are subject to close monitoring through the regular NHS Connecting for Health Service Management process as well as involvement in ongoing reviews and upgrades. Key personnel from all three Strategic Health Authorities in the south meet each week with NHS CFH, Fujitsu and Cerner to review and monitor progress and plan for future go-lives.

“In summary a key lesson learned is that in order to make the most of this system the preparation has to be very extensive and meticulous, with compliance with the training necessary.

“The increased functionality also creates an environment in which it is easier to make mistakes than the more limited old systems. This focus on processes and training would minimise the number of (quite natural) errors that staff may make and therefore would minimise the capacity of the system to absorb errors without anybody knowing.

“Another key lesson is to share lessons learned and make sure that any teething troubles are captured and dealt with. For example, although administration staff are getting used to the system, it does sometime seem to take longer to do the same event than before.

An example of this is seen in ordering results and such like through the system.

“It is agreed that some activities may take longer earlier in the process, but this saves time and patient inconvenience later. We expect that ordering will have a net improvement in efficiency over time. What is important to note is that the Trust has worked very hard to understand the opportunity and limitations of the software and the results of this work are being shared with the supplier and other trusts.

“Another example of an issue that is being dealt with in a shared capacity as part of lessons learned is that of ‘reporting’. All Trusts need to provide reports on areas such as inpatient, outpatient, day case activity, etc. to our funding Primary Care Trust. In addition, we can use this information to monitor and learn from our own performance.

“Currently, there are some difficulties in completing some aspects of reporting. This is caused by a combination of data migration issues from old systems, adherence to defined processes, training and the flexibility that exists within the Cerner system that enables short-cuts to be taken.

“The data and reporting area suffered the largest number of issues at the beginning, and although the majority of the issues have been resolved, work continues on some significant issues, with solutions being delivered more slowly than we had hoped .

“To combat this, improvements have now been made to the local version of the new system; technology and process changes have increased the awareness of what is required by the system; and improved data quality during data migration has also helped alleviate the issue. Future deployments are being re-planned to reflect the learning to date.

“In addition, a reporting taskforce has been set up, consisting of experts from the NHS, NHS CFH, Fujitsu and Cerner. The aim of this group is to fully ascertain where there are still reporting issues and close them down, not just by the use of tactical arrangements (which they have already developed for use in the short term) but by fully understanding the root cause and by making robust changes to ensure that this is fully mapped, understood and resolved.

“A continuous evaluation and improvement review process is planned after each implementation and a thorough review has been carried out at all of the go-live sites to date. The lessons learned from these were widely shared with the upcoming deployment sites both through improved guidance and at a number of workshops for staff.

“I hope this is helpful

“Yours sincerely,

“Anne Eden

Chief Executive.”

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