Barts still struggling with Cerner CRS

03 Oct 2008

Barts and the London NHS Trust is still struggling to fix problems resulting from the installation of a BT delivered Cerner electronic patient record system.

Six months after go-live, the system is said to be hindering the trust in hitting national waiting time targets, including the 18 week total wait. The trust is having to validate activity data every week to correct errors created by the system.

The inability to accurately record and report activity data -- partly the result of staff recording outpatient activity as inpatient care -- has also created a financial shortfall. In September, E-Health Insider reported the trust was projecting a £3m shortfall in income this year due to the data problems.

The Cerner Millennium electronic patient record, also known as a Care Records Service, was installed at the trust in April as part of the £12.7 billion National Programme for IT in the NHS.

Since go-live, the trust has reported a series of problems. The software, which initially focuses on patient administration tasks, has also made basic activites such as managing outpatient bookings more difficult and complex.

In June, the trust reported that problems with migrating outpatient clinic data had led to delays in care for 11 cancer patients, breaching national wait targets.

September board papers report that continuing problems with the CRS software meant the trust missed more key targets in July; 54 patients breached the 26 week inpatient appointment target and 44 the 13 week outpatient waiting time target.

Although it has made progress, the trust reports incomplete data continues to create problems with meeting the 18-week target. “A significant level of validation is required on a weekly basis to correct data errors post CRS implementation.”

In his September report to the board, trust chief executive Julian Nettel says CRS was the main reason for the missed target. “The causes of the breaches were multi-factorial but were predominantly due to operational and reporting difficulties following implementation of CRS.”

He also says remedial work continues: “An intensive work programme is continuing to address the outstanding issues arising from the implementation of the Care Records Service (CRS) which have impacted on trust operations.”

Andrew Holden, the trust’s financial director says in his board report that the trust faces financial pressures resulting from the difficulties with the CRS. “There are on-going recording issues arising from the implementation of CRS which may impact on activity and associated income.”

Jon Hoeksma

Reader's Comments

Costs an extra 2% of turnover to run

03 Oct 08 07:49

It seems that CERNER R0 costs an extra 2% of income to run - extra data input, extra clerks to input, extra error checkers - and even then does not generate the right high quality data for PBR.

You alrady have articles on this in relation to Southern Cluster Trusts

Looks like London version may be no better.

Looks like we are heading to Michael Moore "Sicko" type care system - if the same type of systems go live across England we will be spending £100s millions, ONLY to track money, instead of spending money on frontline health care, combined with activity audit and qulaity control of care.

We need to know how much work we do (not to the last Kleenex tissue), we need to know we do it well clinically, that patients feel good about the care, and the total cost. Tying each patient to costs for income generation,may actually decrease overall cost efficiency.

Learning lessons

03 Oct 08 08:14

A clear case - is there not - for putting the Cerner deployment programme on hold immediately, working with Barts to see if the problems are remediable, learning lessions, and saving other Trusts time, effort and money?

Common sense really!

Project Management on the Cheap

03 Oct 08 13:30

Was there any real business process analysis done - to document existing business processes (which should have included reporting requirements), how those processes whould be affected by Cerner Millenium, was training properly delivered - and are trust staff actually following business processes as they should be?

This is all bog standard (or should be) Project Management - I keep seeing NHS projects fail to deliver benefits because the basics of project management are not in place because they "don't need an 'expensive' project manager - they can do it themselves"?

Read about Australian IT in healthcare

04 Oct 08 06:20

http://healthcareitaustralia.blogspot.com/

Are any of the CfH systems fit for purpose?

maryhawking@tigers.demon.co.uk

04 Oct 08 19:57

As I understood it, the reasons for establishing NPfIT were that bulk buying of IT for the NHS would save money, allow staff to move between diffrent hospitals and not have to learn new ways of working, and to enable/force business change - including the introduction and enforcement of EPRs (which to a GP means not using paper at all).

It seems that this is simply not true: Fujitsu left partly because every Trust was demanding alterations to fit their needs, Millennium R0 cannot accommodate the requirements of the NHS such as C&B and smartcards, Lorenzo - which was expected to be deliverable in 6 months - has still not been delivered and when it is delivered will be pretty basic - a PAS more than a EPR system.

My understanding is that neither Millenium nor Lorenzo (when it finally arrives) will support prescribing/medication management or anything a GP would regard as a patient record.

Please, someone, tell me I'm completely wrong? *Before* we, in primary care, get Lorenzo Regional Care imposed upon us.. ;-<

expensive experiment

06 Oct 08 01:14

Jon,

Based on commenter number 4, Australia IT service may be using the same Horlicks recipe. This bespeaks an urgent need, at Barts and other trusts, for a deployment moratorium to allow aftermarket surveillance of current installations. This should include a detailed analysis of the clinical problems and complications from these actual experiments in altering the administration of medical care. How many deaths and injuries have there been? Until that is studied withoout conflict of interest, commenter number 5 can not be told she is wrong. Thank you for publishing this.

Sincerely,

Propensity

RE: Are any of the CfH systems fit for purpose?

07 Oct 08 22:42

I have noticed a few comments from Mary recently, which are ill informed and very negative.

Lorenzo was delivered last month in its initial form at South Birmingham PCT and is due to be implemented elsewhere in a few weeks. It includes at present clinical noting, assessments and requests and results, plus but in the next release a lot more, including PAS of course.

Please speak to your SHA or whoever and get booked onto a demonstration or something, and then at least the comments can be accurate and not completely negative!

2% of turnover

08 Oct 08 08:56

So over the Cerner patch, that would be about £1bn EVERY year ! Buys quite alot of patient care, £1bn does.

Mary - Yes You are completely wrong

09 Oct 08 00:45

Quite where you get the assumption that Lorenzo will be more of a PAS when it is delivered is beyond me ?

Let me say this again - Lorenzo is not a PAS

It has no PAS capability in it's release 1 at all, it is entirely a clinical application.

Why not go and have a look at Lorenzo somewhere before commenting and obviously Cerner is C&B compliant.

Re: Fit for purpose

09 Oct 08 08:56

It's interesting to hear that Lorenzo was implemented at South Birmingham PCT last month. By this stage, then, we should be in a position to hear from the users about how they are getting on with it.

This would be important intelligence / learning before widening its roll-out over the next few weeks.

Foot and Mouth

09 Oct 08 11:35

Wasn't South Birmingham PCT a Podiatry installation? Hardly a rigorous test?

Expensive Project Manager Speaks

09 Oct 08 12:53

In response to the comment at numbe 3.

I am a full time Project Manager, with a track record of success in PCT NPfIT projects.

I had the dubious pleasure of working with (against?) Fujitsu on a Cerner implementation that failed, thank God, to go live prior to the pull out. We were not allowed by the ISP to do proper process mapping for the As Is, the To Bes were proscribed and becuase we NEVER saw a functioning Millennium system we could not validate any process.

The Project team fought Fijitsu for sight of the system but 3 months after the first proposed go live date the Business Change and the Training Teams had not seen a live screen. The Business change Team were reduced to searching through demo videos and screen shots to try to find out if you recorded height then weight or weight then height ... No hope of gap analysis, no hope of creating training packages...

Don't blame the Trust Project Teams most were fighting hard to get a safe effective and useful system in place starting with a pile rubbish and being told we "dodn't understand the technology" ...... We did! The troubles at Barts prove that we did! In the end the powers that be forced us to move forward with something we knew was not fit for purpose.

Warning - may contain irony

09 Oct 08 13:13

Mary

You have to understand that Lorenzo will support any requirement anyone can think of in Primary, Secondary or Community Care: be it EPR, prescribing, a cure for the common cold etc. in three months time.

That's the way the game is played around here. ;-)

Re: Expensive project manager speaks out

09 Oct 08 15:00

If the project management is that good, there will - of course - be a lessons learned / end-of-project report in which all these difficulties are documented.

As it's a PCT, this should be in the public domain / available under a FOI request. If only we knew which PCT ....

Cerner R0 - fortune favours the sceptical.

09 Oct 08 21:53

As someone immersed in the early days if the Cerner R0 implementation at Weston General Hospital, it is astounding that trusts are still stepping up to the block, laying their head down and effectively hoping that the axe falls cleanly, without getting proper access to other R0 implementers. The main editorial to this issue comments that we must aim to get "maximum results for NPFIT"... in this financial climate we cant afford to be letting loose this second rate system (Cerner R0) designed for a totally different business model (US) and bodged (badly) to fit, and seeing what unecessary costs incurred each time.

a panacea?

10 Oct 08 13:33

"You have to understand that Lorenzo will support any requirement anyone can think of in Primary, Secondary or Community Care: be it EPR, prescribing, a cure for the common cold etc. in three months time."

Will it do prescription of methadone with daily interval dispensing? (~30% of my practice).

I hope so

10 Oct 08 15:39

"Will it do prescription of methadone with daily interval dispensing? (~30% of my practice). "

What with the progress of NPFIT and the current economic crisis we are all going to be needing it.

ePrescribing - LORENZO as well as others

10 Oct 08 16:06

"Will it do prescription of methadone with daily interval dispensing? (~30% of my practice). "

No - "Advanced Prescribing" has yet to be developed......as is the recording or medicines administered to the patients on the wards in the acute sector.

And - IMHO the development work required to deliver "daily interval prescribing of methadone" functionality isn't rocket science. Try varying rate combination IV infusions with full compatibility and the full range of contra indication checking thrown is as well?

Those in charge of developing ePrescribing (all of them - not just iSOFT) need a reality check - listening to the advice of their own experienced staff (who do have clinical backgrounds) would be a good starting point. Overriding their design decisions "because its to difficult to do" just isn't good enough. These applications have the potential to kill as well as help cure the patient.

Roll on user acceptance testing......

Dont Trusts talk to each other

11 Oct 08 13:19

All Trusts have had similar problems with reporting following deployment of Cerner Millennium. The issues and problems have been well documented in lessons learnt reports – the key message is don’t deploy until you have fully tested every aspect of the reporting functionality !!!! and remember as part of testing to change data after having run a report to see what the impact is next time you run the same report !!!! But above all else pick the phone up and contact your counterparts in Trusts that are using this software – you might just learn what is happening in the real world (and not the world according to the supplier or NPfIT).

Reinventing the Wheel

13 Oct 08 11:16

....should this not have formed part of the Project Initiation Document and high level project plan?

Taking on board the lessons learned from other trusts' who have used this software and have experienced difficulties should have been done and the project steering group (i.e. the trust) raised issues/ risks and escalated as necessary.

The secrecy surrounding NPfIT implementations is not helping at all.

Warning: may contain irony

13 Oct 08 19:20

So, would it be fair to conclude that Mary was right after all?

Point of order

15 Oct 08 08:09

Surely we need to ensure that the article's content is accurate before reeling off comments?

'patients breached the 26 week first outpatient appointment target and 44 the 13 week inpatient waiting time target.'

The last time that I checked, the OP target was 13 weeks and the IP target, 26???

(EHI Editorial note - this error was included in an earlier version of the story and has since been corrected)