iSoft system leaves North Staffs unable to bill

Tags: A coding CSC EPR iCM iCM iPM iPM iS iSoft Lorenzo Quality Solution

16 Oct 2006

University Hospital of North Staffordshire NHS Trust, one of the most indebted trusts in the country, is facing a potential £16m risk due to severe problems with a new electronic patient record system from iSoft, which have left it unable to code activity and recover income.

The new system has left the trust, which already has a deficit of £15m and is shedding 1,000 staff, incapable of produce the activity reports required for billing. The trust puts the potential financial risk for the full year between £4.5m to £16.2m.

In the first quarter of the year the lack of activity data cost the trust £450,000 of income – though this has since been recovered.

The problems have arisen from a project to install versions of iPM and iCM, the two key software systems currently being offered by iSoft to the NHS IT programme. After extensive delays the project went live this July.

The project which has occurred outside the NHS National Programme for IT was signed between the trust and iSoft in 2003 and originally due to have gone live in March 2004.

According to the trust board papers the problem stems from the new data warehouse associated with the EPR. Activity reports needed for billing have been impossible to generate due to “the failure so far of the system to collate appropriate identifiers to the work”, and the “high level of coding backlog” that has as a result built up.

The October board paper states: “While significant effort is being put into resolving these issues little meaningful progress has yet been made. These issues must be resolved as a matter of urgency if the trust is not to suffer a major loss of income, impacting materially on the 2006/7 out-turn.”

A trust spokesperson told EHI: “Since the publication of that particular paper, the first quarter issue has been resolved and the £450,000 has been recovered in full. The trust is continuing to work with iSoft on issues surrounding billing for the remaining three quarters of the year.”

The spokesperson added that progress has been made and the trust was confident the problem would be resolved. “This particular problem is not about the functionality of the EPR system but about data management within the data warehouse. The quality of the data itself is not in question.”

A contradictory view was offered by iSoft. A company spokesperson said that the problem was historic and associated with the 15-years of historic data that had to be migrated. “There were also issues of data quality,” the spokesperson told EHI. "The two year delay has been due to the quality of the data. There are still some problems with translating data from iPM and iCM to the data warehouse."

In addition to the problems with reports and billing, the trust is also experiencing severe problems with core clinical functionality of the iSoft software. Last week it had to advise staff that the ability to order patient tests – a key feature of iCM – had been switched off. “Due to technical difficulties, trust department/wards will be unable to view results via iCM until further notice.”

The spokesperson confirmed that the trust “had experienced a problem with the package that had left staff unable to use iCM”. They stressed that back-up arrangements were in place.

“I think it’s fair to say that this is a big IT system and very complex, and it’s taking longer than hoped to get it working properly.”

The problems with the joint iSoft iCM/iPM solution will be of particular concern to other trusts as it is the software being offered by Computer Sciences Corporation (CSC) to 60% of NHS trusts under the £12bn NHS IT programme. CSC is currently being forced to offer the older software as versions of iSoft’s new Lorenzo system, originally due in 2004, are now not expected until 2008 at the earliest.

Link

North Staffs announces 'big bang' implementation

North Staffs prepares for big bang

Readers Comments

situation becoming clear

20 Oct 06 09:48

As one of the staff soon under threat of the next round of redundancies at this hospital, I feel angry that I have not been informed by my own employers of this situation.

There was a press release soon after go-live singing the praises of the successful implementation of the new system, warning patients of delays whilst teething difficulties are ironed out. Isn't it ironic that the very system that is meant to help staff do their jobs and improve the patient experience is actually partly to blame for staff redundancies? When our senior politicians deny what's happening and our hospital leaders say that redundancies won't affect the patient services, I would like to ask them which 4th dimension are they living in and does it have a working fit-for-purpose IT system that we can borrow? (apologies for the rant but I do feel a bit better now, thank you!)

I blame the scapegoats! Or a tale of 1/10th of 1%.

20 Oct 06 21:09

Let's look at the facts.

The financial problems at North Staffs probably go back to its inception and are typical of large Trusts formed by the merger of debt-ridden smaller trusts with no debt relief by central government to at least give them a fighting chance of economic survival. They were also given impossible cash releasing efficiency saving targets on top of a 3.5% capital charge (i.e. an annual charge is levied against Trusts equalling 3.5% of any assets they own).

Problems were compounded when in the middle of an election Tony and Gordon decided to scrap the organisations (SHAs) intended to broker financial balance across a local economy (ironically encouraged and cheered from the sidelines by the very Trusts about to hit the rocks of financial ruin as a result).

Next, due to a DoH cock up, PbR tariffs were changed and anticipated incomes slashed - AFTER spending plans for the year had been drawn up (I think the effect of UHNS was about -£45m per annum).

Finally as a result of new rules following the scrapping of the SHAs the DoH extracted any surplus from a health economy into a central bank, whilst forcing all organisations to achieve income/expenditure balance whatever their inherited debt.

The result is umpteen large Trusts with massive debts being forced to cut services and scrimping on essential activities such as data cleansing and business process changes essential for successful benefits realisation of an EPR deployment.

North Staffs temporarily "lost" £450k - a very small percentage (now recovered) of the -£45m impact of the PbR cock up by central government on this particular Trust.

For the record - I don't work at this particular Trust but there are parallels locally and I was nerdy enough to look up the Trust's annual report on Google.

http://uhns.immediacy.info/PDF/Annual%20Report%202005-6.pdf