The first go-live in the South of England of a pivotal part of the NHS's £6.2bn national programme for IT (NPfIT) has caused significant disruption at a hospital in Oxford and put the safety of patients at potential risk, according to NHS documents.
Nuffield Orthopaedic Centre filed a "serious untoward incident" report with the government's National Patient Safety Agency after the fraught implementation at the hospital of a Care Records Service for sharing electronic records nationwide.
Serious untoward incidents are investigated by the agency when they have, or may have, caused death, serious injury, contributed to a pattern of reduced standard of care, or caused serious disruption to services.
Nuffield papers said the trust had identified "major issues of patient safety" such as patients being "lost in the system". This could involve patients being "lost" from waiting lists or not being called in for treatment.
The installation of a Care Records Service at Nuffield has also caused what the trust calls "major operational difficulties" including a backlog of appointments and an inability to produce both internal performance reports and those required by Whitehall. These include some details on the size of the waiting lists and cancellations. The trust insisted that patient safety had not been affected.
Hospital executives said they had little choice but to go live with the risky implementation of the system - although there had been inadequate time for testing. The Care Records Service replaces a patient administration system that was built in-house, and was expected to fail completely in February 2006 due primarily to its age and an overload of data.
The trust had been due to replace the old system in 2004 but its procurement was halted by the advent of the NPfIT. Under the national scheme, patient administration systems are bought centrally under contracts with four local service providers.
Further delays occurred when Fujitsu, Nuffield's local service provider, switched supplier from IDX to Cerner.
Nuffield finally went live on 20 December 2005, after what it said was a "major effort by the trust and Fujitsu", even though in the week before the switch significant amounts of testing as well as the validation and migration of data were incomplete.
The new system is used in part to call patients into hospital, and track inpatient and outpatient treatment. A report to Nuffield's board on 6 March 2006 said there was a "significant backlog of outpatient appointments" as a result of data migration and other issues. This backlog and other problems arising from the go-live were described as "critical issues" for the hospital.
In the paper to Nuffield's board, Jan Fowler, executive director of nursing and operations and the trust's executive lead for Connecting for Health, the agency which runs the NPfIT, said, "It is likely that it will take the trust some months to address all of the issues which have arisen as a consequence of the Care Records Service system implementation."
Fujitsu won an £896m contract in January 2004 as part of the £6.2bn worth of deals awarded under the NPfIT. Given the problems at Nuffield, the hospital's audit committee said it wanted to know who in the NHS was taking redress against Fujitsu.
After the go-live at Nuffield, staff reported that, "Major configuration and software problems led to significant operational disruption, and potential risk to patient safety, business continuity, staff morale, and public and patient confidence."
The hospital's audit committee said Nuffield had a duty to inform other trusts about its problems.
Fowler said that two days after going live, the system "went down completely" due to a power outage at the datacentre and the failure of the failover processes. This affected all radiology information systems in the South of England, but at Nuffield resulted in a "full working day without access to the system".
Since then there have been a "range of significant problems" with the Care Records System and these have "caused major operational difficulties".
Fowler said the problems were caused by "inadequate configuration of the system for use at Nuffield, and a lack of testing of that configuration, and resilience testing of the system overall, due to the time constraints within the implementation programme".
Supporters of the NPfIT have long feared that a disruptive implementation at a hospital trust of a core component of the programme could diminish enthusiasm for the programme nat- ionally.
A spokesman for Connecting for Health said, "The Nuffield Orthopaedic Centre (NOC) had an urgent need to replace an obsolete and overloaded IT system. In response to the need, NHS Connecting for Health, working with NOC, installed a new hospital-wide system within some 12 weeks of signing the contract with suppliers. The deployment has led to some issues which, regrettably, caused inconvenience to patients and staff - though there has been no adverse impact on patient safety.
"The trust, NHS Connecting for Health and Fujitsu, the local service provider, are fully engaged in addressing the issues. Intensive work by all parties has already resolved the vast majority of issues raised and we fully expect the remaining small number of concerns to be resolved in the near future.
"At the same time there have been successful deployments at NOC of Picture Archiving and Communications Systems and Radiology Information Systems. In the coming year there will be more than 20 such installations in the NHS Connecting for Health Southern Cluster and we will ensure that lessons are learned from each deployment."