The chief executive of the first NHS trust in Southern England to go live with a key part of the health service's £6.2bn IT-based modernisation has warned that problems with the deployment have created a backlog of work that means patient care may have to be moved to other hospitals.
Ed Macalister-Smith, chief executive of Nuffield Orthopaedic Centre in Oxford, also said, in a letter leaked to Computer Weekly, that the trust had organised "extra clinic and operating time".
The trust has implemented a basic "version zero" of the Care Records Service, which includes a system that may eventually allow electronic patient records to be shared with other hospitals.
The difficulties encountered by Nuffield are among the most serious hospital staff anywhere in the UK have experienced after the implementation of a major new system. Some operations have been cancelled and treatments for patients delayed.
The Care Records Service is a pivotal part of the NHS national programme for IT. It includes a patient administration system that records details of the care and treatment of patients and is supposed to produce statistics on whether government targets on waiting times for operations and other treatment are being kept. It also helps to schedule patients for operations and treatments.
But since going live with the Care Records Service the trust has been unable to produce some statistics on its waiting times, has been in danger of breaching government targets on when patients are treated and, according to internal papers, some patients might have been "lost in the system".
The leaked letter, dated 10 April 2006, said that some parts of the system were working well - better than the trust's old patient administration system. But "major difficulties" needed to be overcome if the trust was to "ensure that we can pull consistently accurate reports from the system".
The letter said the aim now was "to catch up with patient treatment" by the end of April.
After going live on 20 December 2005, the trust and Fujitsu, the supplier of the Care Records Service to trusts in southern England, have worked hard to resolve the difficulties by the end of February.
But a report to a meeting in April of the board of Thames Valley Strategic Health Authority, in whose area the Nuffield operates, said that the Oxford hospital had received software fixes "for all known major issues, but several have not resolved their technical problems and there is an ongoing process of developing new technical fixes".
In the leaked letter, Macalister-Smith thanked staff for their "extraordinary efforts" in tackling the problems and for "sticking with the system".
He added, "I can confirm that our experience at Nuffield Orthopaedic Centre has been used to substantially change and improve the next stages in the implementation of the Connecting for Health programme across the south of England," though he accepted that this may be "a small comfort".
Macalister-Smith's letter said its purpose was to update colleagues on the implementation of the Care Records Service and "delayed patients".
It said, "Some patients waiting for in-patient or out-patient care at Nuffield Orthopaedic Centre have unfortunately been delayed as a result of the problems that we have had.
"In order to catch up with their treatments by the end of this month we are taking all necessary actions in-house and with our primary care trust colleagues. This is already involving extra clinic and operating time and may involve moving some patient care to other hospitals. I apologise for the extra work involved, but these delays are, after all, not the patients' fault and we need to maintain our reputation with them."
In a statement to Computer Weekly, Nuffield made no reference to the extra clinics or Macalister-Smith's warning that patients may be moved to other hospitals.
It said, "No patient's clinical care has been compromised as a result of the difficulties that have been experienced with the implementation of the new IT system. Unfortunately, there have been some patients who have experienced some delays or been inconvenienced and we are working hard to resolve these issues."