The first hospital in England to install a smartcard-based Cerner system under the health service’s £12.7bn IT modernisation scheme faces indefinite, multiple problems, according to an internal NHS document.
It discloses that since the Royal Free Hospital, Hampstead, installed systems in June 2008, under the national Care Records Service scheme, there have been risks to patients, breaches of security through smartcard sharing, long log-in times which discourage staff from using the system, and information having to be written on paper – making parts of the new technology redundant.
There have also been system crashes, sometimes twice or three times a week, and extra staff needed, in part to "minimise clinical risk".
The paper "Lessons learnt from the Royal Free Hospital Emergency Department" was disclosed by an NHS employee and has been obtained by Computer Weekly. It gives an insight into how difficult it will be for suppliers and the NHS to maintain the smooth running of hospitals while installing standardized national systems into complex hospitals across London and south of England, all of which have different ways of working.
A spokeswoman for the Royal Free said that some problems with the system "will take some time to sort out".
If similar problems arise from other implementations in the south and London, NHS staff may find that it takes longer to do what they did before, which could mean they care for and treat fewer patients. Some patients may be put at risk if they are lost in the system or their condition is under-estimated through mistakes on the system or a lack of information. The paper also highlights the risk of clinical time being wasted dealing with system work-arounds – or the IT going unused because of the difficulties.
The paper says the implementation of the Care Records Service at the Royal Free was "particularly difficult for the emergency department".
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 to 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.
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