CSC re-negotiating delivery of Lorenzo

25 Sep 2007

Lorenzo: the clinical software for 3/5 of England

Lorenzo: the clinical software for 3/5 of the English NHS

The contract for delivery of the core strategic clinical software meant to be delivered by the NHS IT programme in three-fifths of the English NHS is being re-negotiated, with talks due to run until the end of 2007.

At the centre of the contract revisions are further changes to the delivery schedule for iSoft's late-running Lorenzo software.

The contract negotiations are occurring between iSoft, its prime contractor Computer Sciences Corporation (CSC) and NHS IT agency, Connecting for Health (CfH).

A spokesperson for CSC confirmed to E-Health Insider that contract revision negotiations are occurring. A parallel but separate set of contract negotiations are also underway in the South of England with local service provider Fujitsu.

CfH confirmed that a contract discussions are underway with all three local service providers. "A similar 'reset' process has taken place with other Local Service Providers."

E-Health Insider has learned that plans for the delivery of the much-delayed Lorenzo software, last said to have been due in mid-2008, is at the centre of the negotiations. Isoft first promised to deliver a version of Lorenzo to the NHS by the end of 2004.

Many revised delivery schedules later, the most recent stated CfH plans had called for iSoft to deliver its new Lorenzo software in two releases. CSC was to get the first of two Lorenzo releases from iSoft by the end of 2007 and start installing the software at NHS sites by mid-2008.

But new plans are now being negotiated to break Lorenzo into four releases, with a scaled back first release for early 2008 and further releases to come at dates yet to be agreed.

Alan Spours, chief information and knowledge officer for NHS Northwest told E-Health Insider that the move was a positive one for the NHS, offering the possibility of key clinical functionality arriving earlier than it otherwise would. "A lot of us felt that Lorenzo arriving in just two releases was a bit much, we didn't want to have to implement everything in one fell swoop."

He stressed that under revised plans the first phase of Lorenzo would contain a lot more clinical functionality, and deliver it slightly earlier than previously. Spours said Lorenzo release one would have clinical content including "orders, results and clinical documentation".

The NHS Northwest CIO said that under the revised plans the aim would be to have "three early adopters by April/May 2008".

Details of the revised Lorenzo plans also come in board papers for NHS North West "CSC have put forward a release strategy for the strategic software product Lorenzo, leading to software being released to the NHS in four phases rather than two." The date for release one is projected "as early as April 2008", rather than June 2008.

The papers state: "Releases 2-4 are expected to be delivered later than originally planned, and CSC is expected to confirm revised timelines shortly."

The revised approach is described as a positive development that "will reduce the risk around delivery to CSC, but is also welcomed by the NHS as it will provide a more flexible approach to deployment across the Northwest."

Contract revisions are expected to last up to four months: "The new approach will require a revision to the existing contract with CSC, and it is envisaged that this will be undertaken in the next 3-4 months." It says that revisions to the contract will be "ultimately signed off by the NME [North East Midlands] Programme Board".

CSC's late delivery of software is described as a problem for trusts across the Northwest, leading to delays. "The NHS still has issues with regard to CSC delivery of software and maintenance upgrades in 2007/8, and as a consequence a number of planned deployments in the areas of Child Health, Acute PAS [Patient Administration Systems] and clinical applications will experience delays."

Similar problems, even extending to descriptions of the software to be delivered by CSC, are also reported in Yorkshire and the Humber Strategic Health Authority. In a September board paper the SHA says the top risks identified by the National Programme Executive Committee are: "Delivery of LSP product descriptions and delays to some LSP products". The paper adds: "SHA has insufficient clarity on LSP contractual commitments."

Spours told EHI that after a lot of delays Lorenzo may yet prove worth waiting for. "There's been a lot of very positive feedback from those close to the action and delivery of this product", but he predicted that such a positive impression "will take a bit longer to get through to the grass roots".

The NHS Northwest CIO summed up: "The product is potentially is fantastic, but the proof of the pudding is in delivery."

Jon Hoeksma

Reader's Comments

Proof of the pudding

nhstechie@btinternet.com

25 Sep 07 00:29

Most NHS folk thought CSC's two release strategy was too big a step change - the training implications were colossal on an instance shared across multiple Trusts.

The real proof will be whether Release 4 slips beyond 2010 and whether it includes everything promised in the OBS back in 2003, or whether there is suddenly a "Release 5" containing all the hard to do functionality such as Integrated Care Pathways with complex multiresource scheduling, rostering and useable real-time bed management.

Interesting that this news was broken by an SHA - perhaps a sign of NLOP starting to have a real effect?

Nit Picking...

jon@e-health-media.com

25 Sep 07 09:55

Dear NHS Techie,

Your comments always valued.

Just a tiny point but it wasn't the SHA that broke the story but E-Health Insider, based on calls and research.

Best regards

Jon Hoeksma Editor, EHI

It's all a bit vague .....

25 Sep 07 11:02

The "possibility" of key clinical functionality arriving earlier. No cast-iron guarantees then?

The "aim" would have to have three early adopters. No obligation to deliver then? No firm plans yet?

Lorenzo "may" yet prove worth waiting for. Let's all hope so!

And just to correct the proverb: The proof of the pudding (system) is actually in the eating (using); not in the serving (delivery)!

Benefits of Lorenzo salami-style?

25 Sep 07 13:01

I suppose it is possible that if they can keep stripping out functionality and define a small enough product, they might be able to deliver a Lorenzo at some point. I think that bits and pieces functionality will be difficult to sell to trusts and difficult to implement in a way that generates benefits for users or patients. Could generate a tick in a box, a payment to the LSP and a 'success' for CfH though so there could be some 'wins' from this. By the way, there is more to the proof than the eating - it is indigestion that worries me.

Presumably the new contract reset negotiations will involve some hefty payment penalties from the LSPs as they have clearly failed to deliver PAS and clinical systems to all acute hospitals by now or even to produce a complete product that could be deployed. Also, we must hope that there will be cash for trusts that have spent large sums preparing for go-lives that could not happen because of late delivery of a fit for purpose solution.

Early adopter or testers?

25 Sep 07 13:19

Has the clinical functionality of Lorenzo been tested anywhere, or is this what the "early adopters" do? Is this software CE marked, ie approved by MHRA for use as a medical device?

Nit picking II

nhstechie@btinternet.com

26 Sep 07 00:14

Hi Jon,

Guess my point was that in the past you'd have been lucky to get an attributible "no comment" from anyone not directly employed by Mr G, given advanced permission in triplicate and signed in blood to talk to you!

As ever, your research is on the button :-)

Worse than you think

26 Sep 07 13:13

You say in your article: "Isoft first promised to deliver a version of Lorenzo to the NHS by the end of 2004.". I was one of the NHS bid negotiators in autumn 2003 and at that time iSoft were promising delivery of Lorenzo in "mid-2004". Lorenzo delivery dates have been fluid to say the least. Expect the announcement of further delays soon - I predict we will get a further 6 to 9 month delay announced in November or December.

What has iSOFT been doing all this time??

27 Sep 07 13:19

Are we STILL looking at a "smoke and mirrors" development?

What has iSOFT (with over 2,000 development staff) been doing all this time?

Lorenzo Electronic Prescribing

29 Sep 07 09:49

Does anyone out there know of any English NHS Trusts who are developing/testing the electronic prescribing functionality of Lorenzo. I would be interested in contacting them to discuss progress so far.

Worse than you think II

maryhawking@tigers.demon.co.uk

30 Sep 07 19:30

Can anyone remember exactly what Lorenzo was when it was supposed to be being delivered in mid-2004? My recollection - as a GP - was that it was a unified single record across all sectors - so all GPs would have to change to it - and "some loss of functionality is acceptable" - at any rate to CfH... I suspect that it is not a single EHR (sounds more like an EPR - by Prof. Protti's classification - an electronic patient record limited to one institution) any more - so what is it? and what will it be - and do - in release 4? Is there any hope at all that it will give the secondary sector the type of functionality which is routine - and mission critical - in general practice?

Lorenzo/iCM Prescribing Functionality

peter.c@nhs.net

01 Oct 07 07:31

In reply to the above

Don't know anyone testing prescribing in Lorenzo (how could they?), but i do know a Trust testing the functionality in iCM (is it different?)

Introductions performed for a very reasonable fee