Some NPfIT PAS systems barely used

Tags: CfH CSC iPM Mental Health NPfIT PAS

21 Aug 2007

A number of Connecting for Health funded patient administration systems (PAS), installed in primary care and community trusts, are only being used by a small number of staff, according to official figures seen by EHI Primary Care.

Internal figures, prepared by local service provider (LSP) CSC Alliance, show an average number of monthly users of just one for North Staffordshire, less than 20 for Cambridgeshire PCT and Bedfordshire and Hertfordshire health community, and less than 50 for Dudley, Fylde Coast and North Cheshire.

Usage figures for PAS systems in the North, Midlands and East Programme for IT show that, in several cases, less than 20 staff are using the CfH supplied PAS system each month.

However, some of the LSPs figures are disputed by the trusts themselves. Dudley PCT produced figures for EHI Primary Care which showed 220 average users out of 400 staff and North Staffs claimed 350 staff were currently using the system and that numbers would rise to 1000 next year, out of a total of 2,000 staff.

Andrew Spence, director of healthcare services for CSC, said the LSP strategy for PAS deployments to PCTs was to begin with low numbers of staff and build up.

He told EHI Primary Care: “Initially we start with a small number of users who perhaps don’t have access to another system and then over time further cohorts are added which is by and large the way trusts want to do it as well.”

Spence admitted that North Staffs “sticks out like a sore thumb” but said the trust had plans in place to expand use of its PAS over the next nine months.

He added: “In November it plans to add 300 to 400 users and then go up to 600 or 800 in spring next year.”

Spence said CSC’s contract with Connecting for Health meant it was paid more according to how many staff were using the system and growth plans were agreed in consultation with trusts.

“The bottom line is that there are volumetric targets so essentially we do get paid more if more users adopt the systems.”

Spence estimated that CSC had installed new patient administration systems in three quarters of PCTs in the old North West / West Midlands cluster and said much lower numbers had been installed in the North East and Eastern clusters formerly run by Accenture, whose strategy had been to focus on TPP’s SystmOne products.

Spence said PCTs were not under pressure to take new PAS systems from CSC.

He added: “CSC’s approach is that we only want to deploy systems when trusts want to take them. If they have got existing systems that they are happy with then that is fine.”

Dudley PCT, which has had a PAS system from CSC since October 2005, showed EHI Primary Care figures which showed an average weekly use of 229 staff between January and April this year. The official CSC figures seen by EHI Primary Care reported less than 50 users.

A spokesperson said: “In Dudley we have trained many administrative support staff to be proficient in entering data on behalf of the nurses and community staff, and in most cases they will be entering for the whole team, so whilst the number of logins is lower than the 400 registered users we are confident that this is in the main due to this factor.”

A spokesman for North Staffordshire Community Health Trust told EHI Primary Care that the trust was half way through implementing its PAS from CSC, with 350 people currently using the system. He said the potential number of users should reach 1000 by April next year.

The spokesperson added: “We expect to realise the benefits as stated by Connecting for Health. It is too early to express an opinion about the experience so far.”

CSC is responsible for delivering new IT systems to three-fifths of the English NHS. Latest CfH figures report that it has installed 99 NPfIT versions of iSoft's iPM PAS system, mostly in its original North West and West Midlands cluster. The majority of the systems have been installed in PCTs, community and mental health trusts.

North West and West Midlands

10 acute

64 community PAS

4 mental health PAS

1 primary care

www.connectingforhealth.nhs.uk/newsroom/latest/yourarea/nwwmids

North East

2 acute

3 mental health

www.connectingforhealth.nhs.uk/newsroom/latest/yourarea/northeast

Eastern

4 mental health

11 primary care

www.connectingforhealth.nhs.uk/newsroom/latest/yourarea/eastern

Across all PCTs and NHS trusts served by CSC the LSP's 'production usage' figures showed that in December an average of 3,300 NHS staff were using the PAS systems it had supplied. EHI understands the usage figures had risen to a monthly average of about 6,500 by early summer 2007.

Readers Comments

Tongue in cheek...?

21 Aug 07 15:01

Superficially this looks like bad news for user numbers... however is one NHS smartcard wedged in each terminal with dozens of staff using it? This is, after all, official policy in community pharmacies ;-)

So....

21 Aug 07 16:52

is this a case of staff filling out paperwork and passing it on to dedicated admin staff who enter it into the PAS system. Makes sense if some staff are spending alot of time out on the road and with patients.

One smartcard - lot's of users...

21 Aug 07 16:56

Let's not forget that some A&E Departments have the same policy too...as reported by EHI some months ago!

Deployment Model

23 Aug 07 09:14

The story is correct that because of a contract that does not meet the needs of the NHS - in that it is structured for a big bang go-live ;it is better to start small and get CSCA and the contract (both of which slow down deployment) out of the way.

Other half

23 Aug 07 17:34

Is if safe to assume that these installations with small numbers of users would have been included in the deployment figures wheeled out by CfH over the last few months?.... now we get the other half of the story....

Value and accuracy from the contract

29 Aug 07 12:34

Worrying if these systems are not even capable of accurately recording user counts, let alone what these users are viewing/changing.

But at least the LSP view of user counts is less than the NHS organisations concerned rather than the other way around.

So who's accountable?

31 Aug 07 09:38

"... however is one NHS smartcard wedged in each terminal with dozens of staff using it? This is, after all, official policy in community pharmacies ;-)"

AND

"Let's not forget that some A&E Departments have the same policy too...as reported by EHI some months ago!"

So ............. when things go wrong, and believe me they will, who will say to the resultant inquiry ......... "Well I just share my password with everyone in the department". Because effectively that is what's happening, using one smartcard could give anyone who uses that PC access to information to which they are not entitled to view. (maybe even the cleaner).

Now turn it around and imagine it was your information that any 'Tom, Dick or Harry' could view. Wouild you be happy?

Information Security is not an IT problem, it's an organisation problem. Collectively the NHS must spend millions on securing it's virtual perimeter but up to 80% of the risk comes from within! - Go figure..........

Who's accountable?

31 Aug 07 18:23

Kudos to the previous commentor 'security isn't an IT problem, its an organizational one".... In finanical services and most other industry sectors that type of behaviour would see the offenders access priviledges suspended immediately.... Healthcare should not be an execption.

System security design can only protect information if end users adhere to the usage standards set out by their organization. The blatant sharing of access cards, userIDs and passwords is a behaviour that should not be tolerated under any circumstances.

A major communication needs be launched to get the message out that information security is everyone's responsibility.

Re: So who's accountable? - IT need to play their part locally

sue.wilson@swbh.nhs.uk

02 Sep 07 12:01

So who’s accountable ??

Information Security may be an organisational issue, but it is still an IT problem to resolve. All IT departments locally have a responsibility to ensure that Clinical IT Systems are enabled by the best technology available. This should not just be left to CfH or the LSPs to determine the best solution for any given organisation. What about Single Sign On solutions? Clinical staff are not just accessing LSP solutions in clinical situations, having to remember just a pin with the benefits of moving freely between systems without keying in passwords, has its own selling point to get individuals to log in. It just takes time and commitment from IT staff to look at the various clinical scenarios and see what they can do to facilitate the processes. It also means thinking ahead in terms of financial planning for IT developments. Unless we play an active part in determining appropriate solutions locally, then we should not be surprised if clinical staff leave smartcards in or take any other shortcuts to ensure that clinical care is delivered efficiently and speedily.

With regard to the number of users logged on, what is all the fuss about? Sometimes I think these letters are any excuse to ‘bash’ a LSP or CfH. Firstly, it doesn’t matter how many users are trained, these figures are generally about consecutive users logged on at any given time. The more clinical functionality deployed, the more the figures will rise. In Community, as one reader states above, “is this a case of staff filling out paperwork and passing it on to dedicated admin staff who enter it into the PAS system. Makes sense if some staff are spending alot of time out on the road and with patients”, then yes, I would most definitely think so. And why not? Until we are able to give clinical staff efficient mobile technology that allows them the freedom to move from place to place and update data in real-time, then a pragmatic approach should be commended.

A final comment to the reader above who states; “……….. it is better to start small and get CSCA and the contract (both of which slow down deployment) out of the way.” It is not in my experience always better to start small when deploying IT systems. This is generally a choice issue as to how fit your local organisation and IT teams are to actually implement IT systems at pace. Some implementations have already been very successful at a big bang approach, whilst others have preferred to roll-out incrementally. As for CSCA slowing down deployment I find quite unbelievable. I am currently coming to the end of a very large deployment – slow, I don’t think so, quite the reverse and an approach I have found refreshing and most welcome. Some of you view the pre-NPfIT days through ‘rose coloured spectacles’. I remember the long protracted procurements; the often messy and lengthy implementations; poor implementation approach and methodologies and key enhancements outstanding, sometimes for 2 years!

No thanks!!

Messy and protracted

03 Sep 07 14:37

In response to a previous comment, one thing I learned in the pre-NPfIT days was that delivering *useful* systems was often (if not always) a messy and lengthy business. Something to do with the nature of healthcare as provided bv the NHS, I think.

messy and protracted

03 Sep 07 20:49

It took something like 2 years for the South to arrive at a "bundle map" to try and describe to the service what had been bought for us (and what was left out as too difficult to specify in these excellent contracts- all the difficult and expensive bits).

We are now in a "Contract Reset". Apparently dispensing with even more of the promised value. I bear the scars rather than rose tinted spectacles of pre-NPfIT procurements, and I know that they were a much better fit with what my local organisations could cope with or afford, addressed local issues well, and are still producing real value.

There are so many compromises in the LSP contracts, and aspects made far more difficult than they needed to be. This has been a messy, very protracted, and so far almost worthless exercise, consuming vast quantities of staff time, cash and goodwill.

Can't identify with the positive comments above at all.