Weston goes live with Cerner

02 Aug 2006

Weston Area Health NHS Trust has become to the second NHS trust in the South of England to begin to use clinical software from Cerner under the £12.4bn National Programme for IT.

The trust confirmed to E-Health Insider that it had introduced the “initial stage” of the new software system over the last weekend in July. It said that this represents the first stage of the development of the electronic patient records – also known as the NHS Care Records Service - at the hospital.

The trust has begun to use the Cerner Millennium clinical software – termed Release 0 - supplied by the local service provider for the South Fujitsu.

The trust told E-Health Insider the software provided includes a patient administration system (PAS) and ‘emergency department’. The trust is the first in the South of England to begin using US-based Cerner’s ‘emergency department’ software for A&E.

“PACS [picture archiving and communications system] is due to follow at the end of the year,” a trust spokesperson told EHI.

EHI understands the full range of functionality in the Millennium system are planend to be used including modules for theatres, reporting, outpatients, inpatients including maternity, electronic whiteboard, discharge summaries and clinical coding.

The spokesperson added that the system had been implemented to be available across the trust. So far the system is understood to largely being used by the A&E department, and initially only by a relatively small number of users, although over 1,700 users have been registered.

Sources close to the trust indicate that the system was switched on despite a number of issues being outstanding. Problems were reportedly being worked on with inpatient and outpatient waiting list software and registering patients.

As of Monday the trust was still working to ‘go live' for elective admissions from inpatient and daycase waiting lists. A 31 July letter from trust chief executive Mark Gritten to staff advised them that for outpatients there was “an issue with the clinic templates, that could result in patients being booked into slots that are not available, or have already been booked into.”

He told staff that work was underway to compare old clinic templates on the previous PAS system with those on the new Millennium system, to make sure patients can only be booked into available slots.

As part of the implementation historic patient data will be migrated. “Data relating to all patients seen in the last three years, all outpatients with pending appointments, and those on current in-patient waiting lists, will be put on the new system,” the trust spokesperson said.

Despite initial teething problems the go live at Weston will come as a relief to Fujitsu, Cerner and the Department of Health. Previously Fujitsu had only managed one troubled implementation of Cerner at the highly specialised Nuffield Orthopaedic Centre, Oxford. With Cerner expected to be officially named the new clinical software supplier for the NHS in London a ‘success’ was urgently needed.

An indication of the importance attached by the DH to Weston switching on a new system comes from the fact that on Monday both the regional implementation director for Southern cluster and Nick Relph, the regional senior responsible office for NPfIT, were all at the trust.

The trust told EHI that it was spending £750,000 on implementing the new system, “but, because this is part of a national programme, the majority of the costs are being met by a national fund, and supporting funds are also coming from the NHS South West Strategic Health Authority.”

Gritten said the new system will eventually “revolutionise the way information is used and transferred across the NHS.”

Gritten added: “Our doctors and nurses will benefit hugely from access to more comprehensive, up-to-date patient information and a fast, reliable means of recording information, which will lead to greater streamlining of clinical practice.

“We are delighted to have taken these first steps towards the delivery of 21st century IT for a modern and more efficient NHS.”

Reader's Comments

Well done Weston

02 Aug 06 11:09

It is good to see the first of the South West EPR consortium sites making progress. There are about 9 further Trusts in the South West at roughly the same starting point - the old South Western RHA computer centre PAS and related systems developed in the early 90's and sold to EDS in about 1994. Well done Weston.

Data migration: NHS CfH policy question

02 Aug 06 12:39

This is another in a line of stories on e-Health Insider to imply that historical data migration is an optional extra for deployments under the NHS CfH contracts.

This may sometimes be pragmatic and would shave months off many schedules. However when it results in old and new systems running in parallel there is attendent inconvenience, risk and expense. Many would regard this a departure from best practice.

Deferring data migration (rather than doing without) seems a worst of both Worlds strategy unless bringing forward a nominal go-live date is the overriding priority.

Can someone please clarify what the official NHS CfH position is on this?

Tradition

02 Aug 06 14:29

Traditionally - where I come from a bottle of champagne is opened (supplied by the solution supplier)....? Some problems may not surface initially - but congratulations to all.

Congratulations

02 Aug 06 14:57

Looks like the London Cluster is in "SAFE" hands!!

Sorry to spoil the party ....

02 Aug 06 16:12

But if - five years ago - a very small hospital had installed a system covering PAS and A&E with just a small number of users, with outstanding issues, data migration still to follow, and another six months to wait before the next promised module (PACS), no-one would have batted an eyelid - and the RID et al would almost certainly have stayed back at the office dealing with more significant issues!

Yes, it's a success of sorts, but it's trivial and the fact that this is considered newsworthy says much about the way the NHS's expectations of IT implementation have diminished in recent years.

When the goal is Everest, successfully climbing a molehill does not really permit any useful forecasting of a wider outcome. The London cluster may well be safe - but it might also be in for a very long wait!

Before we get excited...

02 Aug 06 17:32

Let's be clear about this implementation. WAHT has so far achieved implementation of a small subset of a PAS to replace its fully-functional legacy EDS system, and which for the foreseeable future has nothing like the functionality of the system it is replacing. Unlike the Nuffield OC implementation, WAHT will be a good testbed for the Cerner applications because at least it has a wide range of specialties, albeit that it is probably the smallest trust of its type in the Southern Cluster.

But let's also be clear - WAHT hasn't yet fully implemented the Cerner replacement for its legacy PAS, and until it does, and the lessons learned are known and published, we shouldn't be premature in acknowledging this as a success. I suggest that until what they have implemented so far has been running for at least a couple of months - and preferably longer - it will be difficult to be absolutely sure that, for example, everything has been migrated successfully etc.

Nevertheless, congratulations, and good luck to WAHT for their ongoing implementation.

... Bring a bottle

02 Aug 06 17:59

The NHS CFH model is to get the first of type working and then deploy over and over again. Just look at how long the first PACS system took and now its workin in 50% of Trusts in the South and London.

The first time is always special.

Not the first time

03 Aug 06 06:55

By all accounts, Cerner's first time (at NOC) was indeed "special". But Weston isn't the first time and what's this NHS CfH implementation model? Is it documented somewhere?

Some praise for the old SWRHA IT system

03 Aug 06 07:45

The legacy EDS system from the old SWRHA was an incredibly rich, integrated collection of hospital IT, with masses of potential, implemented across most of the SW. Hang on, single system covering major functionality, single major league supplier, Region-wide availability - isn't that what we are replacing it with? So why did we let it die in the 90's? It had the potential to be devoloped in to a cluster-wide EPR, all it needed was visionary leadership.

Data conversion not optional, just locally funded

03 Aug 06 11:20

I don't suppose the question above addressed to CfH will get an answer here, so I'll try.

In common with the other difficult areas of Interfacing and local Infrastructure, for expediency, the national contract left these as additional services. This of course has left gaping holes in the 'best value analysis' of the approach, being the areas most likely to be difficult.

On data migration, if you or your supplier can present the data in the format that Cerner require, no problem. But outpatient scheduling looks nothing like any UK designed system, and there is likely to be a signficant amout of data transformation needed.

There are also IQAP standards set by the Cluster on presence of NHS Number and other items which eliminate some records from eligability. The ability to do casenote tracking for imperfect records will be affected by these.

It is a Trust obligation to prepare the data. Of course FJA can provide an additional service to do some of this, but there are also costs with existing system suppliers to prepare data for the downgrade.

What have Weston actually implemented ?

03 Aug 06 11:23

It seems that there are limited features on Cerner for A&E, Theatres, Maternity in R0.

Has Weston transferred these, or kept their old systems in parallel ?

"Date conversion not option, just locally funded"

03 Aug 06 16:11

Umm... is that a Freudian slip on the final word - 'downgrade'? Did you mean 'download'?

£750,000 seems a lot...

03 Aug 06 22:13

Most of us still cant believe that the CfH is still struggling to successfully implement counter intuitive American healthcare systems, when there are many successful UK NHS suppliers who have already delivered better, more functionally rich systems that could be implemented accross the NHS tomorrow, but have for some unknown reason been deliberately excluded from the National Programme