Fujitsu’s £896m NHS IT contract to be terminated

1

Deckchairs on the Titanic?

28 May 08 18:48

So we can imagine that BT will "volunteer" to take on the new challenge. At what point does anyone in authority ask the more fundamental question - were these contracts ever deliverable?

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2

Excellent news - but model also broken

28 May 08 22:44

My dealings with Fujitsu demonstrated repeatedly that their staff appeared not to really understand what they were delivering, and that the little of the commercial terms that were visible to the service did not stack up as good value. So I believe termination is the best outcome.

And I say that knowing the uncertainty, delays and difficulties ahead.

But I believe that the model was always wrong, and the products poor. Just substituting another LSP in their place will not fix this morass. What was intended as an integrated record for a locality has shrunk to a very imperfect Acute system, with nothing for mental health or community staff, and poor integration with GPs.

I believe that the centre should go back to defining message and system interchange standards, and providing ring-fenced funds and potentially accredited products, but not monopoly monocultures, that undermine rather than underpin local joined up working.

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3

Why did we have a middle man?

28 May 08 23:03

I have never understood why there was a middle man. Homerton's installation of CERNER works because they worked directly with CERNER, and knew what they wanted and needed. Why Fujitsu? Why BT?

But what will now happen to Southern Cluster Trusts saddled with R0? Who will enable them to reach Homerton level of functionality?

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4

Then there were two....

28 May 08 23:36

So presumably BT will pick up the pieces - not much competition left, is there.....?

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5

Group what's there around a new Social Enterprise

gerard@careprovider.com

29 May 08 01:07

Now there is an opportunity to do something different.

We could start by grouping togther current players/suppliers and their local software houses around a local co-op Social Enterprise to devlop services.

Having the remaining LSPs take over another patch is simply not good enough. ps I'll be Chief Exec....

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6

Re-run of Accenture?

maryhawking@tigers.demon.co.uk

29 May 08 07:58

Last time an LSP withdrew from two contracts, the contracts were passed - without being tendered again - to a different LSP - CSC. The number of possible existing LSPs has now shrunk to two - CSC and BT. Under EU law, does a contract of this size have to be re-tendered? and if not, are there consortia in existence able - even if willing - to undertake a project of this size and complexity, either from the beginning or, in the case of CSC and BT in addition to their current commitments? I live close to the border between CSC and Fujitsu - and my patients also receive treatment in London. Do clinicians (who, according to Lord Darzi, are supposed to be leading all changes from now on) have any right to timely information?

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7

And the next please...

29 May 08 08:14

So, to avoid a near-monopoly for CSC and/or iSoft/IBA, presumably it'll be BT for the South so that the Cerner Millennium strategy can continue unabated? But will it be "London Millennium" or "Southern Millennium"? Can't wait to find out...

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8

Other Fujitsu offerings

29 May 08 09:23

One wonders how this will affect onher offerings that Fujitsu have negotiated with CFH ??

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9

CSC

29 May 08 09:34

When can we expect to see the announcement relating to the CSC negotiations?

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10

Who went wrong?

29 May 08 09:39

Was it Fujitsu or Cerner who have failed here? Fujitsu as an LSP have proven their ability to deploy products which are fit for purpose in a timely and efficient manner (i.e. PACS). How come its Fujitsu's fault that they cannot deploy a Cerner product that clearly appears to not be fit for purpose? If BT take over and carry on deploying Cerner will it be any different? Is the problem with an American product which is not fit for NHS purpose? Are Fujitsu taking a fall due to the fact that they have no product to fit the needs to the Southern Cluster?

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11

What now for NHS staff

ken.stafford@nhs.net

29 May 08 09:49

What happens now to all those members of staff employed just to work with Fujitsu and Cerner.

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12

In France it was the same

29 May 08 10:41

The National programme will never work. In France we tried the same and it did not work, it will not work in england either.

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13

Time to bring in more clinical information suppliers.

29 May 08 10:42

Somehow CfH must find a way of bringing more secondary care clinical information system (CIS) suppliers into the process for the medium / long term solution. Strategic Health Authorities and Acute Trusts need a choice of about 6 CIS suppliers who are competing against each other driving forward innovation and service levels. Maybe each LSP must be "told" to offer trusts a choice of at least 4 secondary care CIS suppliers whose products conform (or are very close to conforming to) SNOMED CT, HL7v3 and dm+d standards. Better still, cancel all LSP contracts and let Trusts work directly with suppliers under the overall control of their Strategic Health Authority. By the way I would define a CIS as a combined PAS and Clinical System working from one database with a minimum number of interfaces to other specialist systems.

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14

Time to pause and take a breath

29 May 08 11:03

Now would be a great time to pause, take a breath, and work out what would work best for the South before rushing into another LSP arranagement. Possible action?: 1) Review whether another LSP arrangement would work - what are the alternatives? 2) Stabilise current Cerner installations - most sites still seem to be struggling with the implications of the new systems. 3) See if anyone else does actually want to take Cerner as planned - most sites seem to be avoiding roll out as long as possible but someone may be desparate for a new PAS. 4) Actually work out once and for all whether Rio is the right MH solution for the South. 5) Review how Cerner is being implemented. I hear rumours from North America that it's a good system being badly installed. How can we make a good system work for the NHS needs?

Personally I don't care who's to blame for the situation - let's look forward and make something work!

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15

Its the Market Stupid

29 May 08 12:10

Stalin tried building tractors this way. Mao tried to produce steel this way. It didnt work for them either. Big centralist Governement controlled projects almost always results in disaster. What we need is an open and well regulated market, with opportunities for service providers to buy the systems their business needs at the time that they need it and at a cost that they can afford. The Governement should provide ring fenced IM&T funds to support service providers if they want things to improve. Giving money to the DoH or the SHA or any other none provider agency will see it squandered on ever more facilitators and auditors. The market will bring prices down. The market will provide innovation. If you want a vision of a grand unified system, set high level interoperability standards and reward suppliers for producing systems that meet them.

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16

What went wrong.......?

29 May 08 12:11

Where can we start diagnosing this? Whose fault is it? Let’s look at this objectively.......

Can we blame Cerner for arrogantly thinking that an American PAS system built around the principals of billing and not being patient centric could be simply changed to fit? I think we can to a degree as the complexity of morphing a system from that starting point to a point where it caters for the UK policies, procedures, legislation & law (for example mental health and capability & consent) is a very large undertaking.

Can we fault Connecting For Health in the South for letting this continue for so long? I think we can as the governance and oversight in the region was poor to non existent in most areas except for the contract monitoring. There is plenty of blame here although to their credit this was recognized last year and changes have been made under NLOP.

Can we fault Fujitsu? Indeed we can. The people at the coal face were working hard and encountering much resistance due to the product suite they were being asked to deliver. The failings were further up the chain where there was a lack of fundamental understanding of what needed to be delivered and how to deliver it.

I don’t think, given my experience of the southern contract, that any party is without blame here and we should recognize that when we move forward. However what can we move forward to?

BT taking over seems a natural choice given its use of Cerner within London however are we asking for the same problems? BT has hardly set the world alight with the provision of their Cerner services. The Newham configuration was purchased for use in the South and provided little impact so the hope of BT using that model is ill founded.

CSC is an option. It has been supplying services to large regions and has being doing so successfully. It's bad press has been centered around the lack of provision of Lorenzo from iSoft however the solutions they have been putting in have been largely fit for purpose and have provided the core services needed. This is a proven architecture and with Lorenzo actually being brought into the country for limited trial implementations the prospect of the full Release 2 of Lorenzo is a reality before the close of the year.

Additional suppliers could be an option. There are many suppliers out there who have solutions that are suitable for provision into the National Program. One such solution is SystemC's Medway PAS which was recently successfully installed on the Isle of Man alongside clinical, community, emergency and other systems. This can be regarded as a template for a LSP contract and it is notable that the project was delivered on time and on budget. However there is the problem of scalability both in terms of the solution and the resources to deliver.

I would personally favor the CSC option however I am sure the Competitions commission would have many things to say about this and I would discount BT which leaves CfH in a difficult position of having to take a chance but one that could pay off.

Who'd want to be in the hot seat over the coming weeks............?

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17

Centralised not so good

29 May 08 12:39

This whole Stalinist project has got out of hand. Managed by ignorant and greedy politicians, it has been sold to an ignorant and greedy industry who are all finding out piecemeal what a pile of poo it really is.

I believe in the dissemination of information to the control and ownership of its subjects. In short, with the cost of mass storage now so low, there is little reason why the patients should not own their own data. For the majority of records a few megabytes will do, while for more complicated cases the currently available gigabytes should be ample. The central role should be restricted to elaborating and publishing an agreed data structure for records, together with guidelines for data coding. At present we have neither in any meaningful sense. The patient, or their guardian should have control over who has access to the record, and this should be granted on registration at GP or presentation at hospital. The grant should be permanent, or temporary at the patient's choice, and all copies should be erased on withdrawal or expiry of the patient's permission. There should be a master copy held by the patient's GP which would serve as a back-up for the patient's own copy.

This would not be an inconsiderable project, but it would have a chance of success and would provide the badly needed security which the current project so conspicuously lacks. It also might be quite a bit cheaper and less prone to catastrophic failure.

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18

Response to Poster 10

ted.yeoman@nhs.net

29 May 08 13:01

Poster 10 ended up by asking the question "Are Fujitsu taking a fall due to the fact that they have no product to fit the needs to the Southern Cluster?" My understanding is that each LSP sourced it's own choice of software to meet the specs laid out in the contract. thus it was Fujitus who gambled on being able to get away with deploying a cheap (slightly modified) off the shelf American offering rather any other system. They Lost ... simple Sadly the NHS, the tax payer, the patient and possibly the NHS Staff and contractors working with Fujitsu lost too

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19

The problem of multiple specialties

29 May 08 13:20

Secondary care computing will always be difficult because it is a complex matrix of care providers and support services. If a Trust has 30 specialties interacting with 20 support services then the one thing you certainly have is an interoperability challenge. If this had been fully taken on board from the start then the futility of trying to shoe-horn legitimate requirements into a single size box might have been recognised much sooner. Abraham Lincoln said "You can fool some of the people all of the time, and all of the people some of the time, but you can not fool all of the people all of the time".

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20

Core PAS Standards

29 May 08 13:37

What is now needed is a core PAS system that conforms to specific coding, data sets and bi-directional interfacing standards in a similar way to the electronic standards. This would open up excellent competition for quality clinical systems to be interfaced and allow Trusts/PCTs to select best of breed. In a similar way a PC motherboard can interface to various electronic components from different manufacturers. Systems are likely to have much better chance of successful implementation if they are driven by the client/clinician then having a top down approach from people who are not on the shop floor so to speak.

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21

DIFFICULT MADE IMPOSSIBLE

29 May 08 13:41

The Southern Cluster was always going to be a tough nut to crack. The same money was allocated to it as for other much smaller clusters. Arithmatic dictates therefore that in order to deliver it the Trusts had to shoulder considerably more of the workload using resources of the skills and quantity that didn't exist. In their infinite wisdom CfH elected not to tell the trusts this so recipe for strain. Furthermore CfH agreed on the Trusts behalf that Newham and Homerton would be adequate to be rolled out as R0. Unachievable as the Trusts wouldn't take it. Didn't meet their needs and they couldn't afford to release the people required to define their needs - get out of that without moving. In Fujitsu's shoes I'd head for the door too.

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22

Allow the software provider into the NHS Hospitals' with immediate effect.

29 May 08 15:19

By the looks of things Cerner are a company that deals strictly in Healthcare IT. Cerner must be allowed to work with the trusts first hand and therefore have a greater rapport with the NHS. This in turn will produce a system that will be delivered on time and on budget. Seems that Cerner have been able to deliver time after time in the USA with a proven methodology that works – They must be allowed to use a methodology that delivers for them and the NHS hospitals. After all they are not the market leaders in the USA because they have a cheap system. It is a general rule of thumb and well known, that if you pay the extra you will get the quality. But once you get into the realms of micro managing a company that is used to working as the prime contractor, you are then in un-chartered areas. Therefore with a project like NPfIT it is important to use proven project methodologies and people who know what they are talking about. We must not experiment with a company that has clout in order to save money.

Now it is understandable why the government chose to go with Fujitsu, as a brand they are renown, however having said that. Just because Mercedes-Benz makes quality cars, one would not task them with making planes or spacecrafts; even though they may have the capacity to do it. The point is one must not experiment with a controversial project that involves Billions of pounds of tax payers money. The tax payer cannot see the project and how it is developing. So there is naturally going to be contention around the project. It is not like engineering a bridge, at least with a bridge or the Olympic stadium you can see it being built piece by piece. A Billion pound IT system is virtually intangible to the politicians, public and staff up until the point it is switched on. So it will not get the level of respect that it deserves and that I am afraid is the way of the world. The NPfIT deserves the respect and the backing for it to be successful, or the people will have to sacrifice parts of the NHS as we know it today.

There are advances in DNA mapping and medical science happening everyday. The NHS needs to be on the bleeding edge of Health IT if it is to be a leader in research and patient care. Therefore an IT system that will stand the test of time must be deployed in this NPfIT cycle. Not interim solutions that keep the NHS fragmented and disconnected. Not only the nation but the world will be watching us and must not disappoint, if we are to keep the NHS at the forefront of patient care, we must deliver!

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23

Doomed to failure

29 May 08 15:26

I have always thought, and argued, that CRS could never work. It didn't have a chance. History has shown that large government computer projects, without fail, are disasters. CRS is gargantuan. They either don't work, come in late, or are over budget. Too often, they go in, eventually, but do not do what they were intended to do.

As to blame, this has to be laid squarely at the top of the NHS, and Richard Grainger in particular. Computer systems always sound as if they're the panacea to all our illnesses. Money is thrown at them, but without thinking them through, or considering the consequences.

It should have been obvious at the very beginning that a one size fits all strategy could not possibly work in an organisation as big or diverse as the NHS. The BMA and health professionals at the sharp end should have been partners, not opposition or worse, kept out. This was the first mistake.

Whether it's BT, CSC or someone else doesn't matter as much as the product which has to be the most important factor.

The Barts and the London BT Cerner system went in recently, and still has problems, as someone else has noted, although not as bad as it could have been. This was a political decision, and was imposed on the Trust against the advice of experienced ICT staff who forsaw significant problems. Unfortunately, all that they predicted came to be. It's about time that management realised that their own staff have so much experience, and therefore a lot to offer. And they're cheap.

I wonder when common sense will take over? Time to reflect and reconsider CRS. I doubt it ever will happen.

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24

Gone but not forgotten

29 May 08 16:26

Contract may be terminated but the next trust due to go live on Millennium in July with Fujitsu in the South (RUH) is still continuing to do so. Good Luck!

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25

Suppliers?

29 May 08 16:47

I worked with Fujitsu, Cerner and CFH on four Millennium Implementations. CFH seemed to learn lessons from previous implementations, but Fujitsu and Cerner never did. The same problems would re-appear time and time again. Fujitsu are partly at fault for employing people without the relevant skills to deploy these systems. I saw people working as specialists who had no idea of hospital workflows or even good communication skills. Fujitsu project managers though on the whole were good. Cerner staff were a mixed bag. the American staff were extremely good, but again some of the British staff did not have much knowledge about the product. This could however be down to the unflexible approach that Cerner has to solving problems. The main issue is that the system will never work well unless they have people working on it who understand the NHS... or at least try to.

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26

Gone but not forgotten 2 - RUH

29 May 08 16:54

And good luck to RUH (Royal United Hospital Bath) for deciding to continue with their Fujitsu/Cerner implementation. I'll think of them every time I drive by in my Rover.

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27

A service is more than software

29 May 08 18:38

Given the experience of the few trusts that have gone live with the Cerner software it’s understandable that attention is focussing on whether Millennium functionality will support NHS working practices.

However, let’s not forget that the contract is not just for software, but for a “service” provided from a remote data centre. Operational issues such as seamless software upgrades and local software configuration without adversely impacting live sites, not to mention resilience and disaster recovery take on a whole new meaning with a user base of more than 40 acute and 30 primary care trusts.

So before jumping from the frying pan into the fire, we must also ensure that the next supplier demonstrates an ability to provide a level of service that is appropriate for organisations depending upon it for the delivery of clinical services.

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28

Fujitsu slogan

paul.bolton@nhs.net

29 May 08 23:17

I think Fujitsu should change their slogan to 'The possibilities are finite'

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29

Appropriate Posting

30 May 08 08:30

for a less biased acount of the Cerner experience, you can always see: Click Here

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30

Open Source, Open Standards, Open Field

nik@onenineone.plus.com

30 May 08 09:07

I think we should retain the best things that CfH gave us - the standards for interoperabililty and data interchange; for statutory reporting; interfaces, Spine services; user authentication, application look and feel; we should actively promote the selection and use of Open Source software for clinical systems, and give back to the Trusts what could never be taken away from them - the responsibility for selecting the right solution for them, from a variety of vendors and partners who would all deliver solutions that could interoperate, based on Open standards.

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31

Foundation Trust Free to Choose anew.......

30 May 08 09:24

Interestingly, previously Foundation Trusts across SPfIT were bound by the NCRS contract that was created before each Foundation Trust's statutory commencement - the FT took on whatever contracts had already been made.

With the Termination of the NCRS Contract, Foundation Trust cannot be bound by that contract as it has ended.

Therefore there is no binding arrangement for FTs to take any NCRS solution across SPfIT.

Indeed they may now be freed from CfH central control and can contract for whatever system(s) they want.

Potentially a great opportunity for Foundation Trusts across the South!

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32

Direct Contact may limit BLIGHT

30 May 08 09:49

The risk from the current situation is that operational healthcare still does not get its decision support and for an even longer time. Putting software providers and end-users in direct contact facilitates speedy and thorough answering of the 'WHY' questions and has in the past resulted in solutions that are locally owned and do deliver benefits. All the vendors are in themselves relatively large corporate entities and could deal within contract frameworks direct and get the local job done. Why can't we try out that model .... again!?! - whether with the existing application solution providers or in fact other vendors who were not 'chosen' in the limited lists of the erstwhile LSPs but do have viable products

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33

Why does it work in Homerton

30 May 08 10:53

Simple – direct working with supplier who understands their product (getting past Fujitsu staff to talk to Cerner staff was near impossible), access to all the functionality on offer – not a very limited subset, configuration at an organisation level, a single site on a single technical environment – rather than multiple sites on a single environment all at different deployment stages – creating a non stable platform etc etc

Compound this with denial or wishful thinking by the original cluster team who lacked the courage, experience or resources to recognise the early warning signs and take early action all exacerbated the problem.

The real route cause – the Southern cluster signed up for Fujitsu to deploy a replacement system without a proper evaluation of functionality against requirements that involved the breadth of users of current NHS systems – those best able to comment on fitness for purpose. After that – both the cluster and Fujitsu were in effect on the same side – with NHS Trusts on the other.

It is only the contract reset process, with the involvement of the user community, leadership of the SHA teams who have learnt from the previous mistakes that have ensured that Fujitsu either delivered what is required – or no deal. Let’s hope this same leadership, user involvement and learning will follow through into whatever the replacement solution will be.

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34

Libel of Cerner?

30 May 08 13:56

Unless the poster of comment 29 has absolute and incontrovertible evidence that comment 22 was posted by Cerner, that person needs to be very careful - as do those responsible for this website. The laws of libel and defamation apply equally to web-postings as they do to printed statements. I have no connection whatsoever with Cerner!

(EHI Note - the post in question has been removed)

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35

Thanks for all the fish

sleepyfox@gmail.com

30 May 08 16:03

This news was disturbing, but entirely anticipated. The contract reset negotiations were always going to be a rocky road and the DoH/NHS/CfH governance model which underpinned the National Programme was always an ill-conceived one that had failure built-in from the outset.

This, combined with the monumental inefficiencies of the big SI prime contractors (there were 16 levels of management above me in BT 'Global Services') was always going to be a recipe for disaster.

Unfortunately the CCC model was the only model that made any sense to the informaticists that underpinned the original conception of the programme as they (rightly) foresaw huge problems with moving independent applications from a time-based event model to a knowledge-graph model in such a way as to protect said independent applications from semantic translation artefacts at the boundaries of the message layers.

The bottom line: this project is the equivalent of the Apollo programme in the 60's, but instead of the solution being solvable by the Sciences (Physics, chemistry, materials science, astrophysics, etc. that we have centuries of experience of honing the scientific method) we are intending to solve a problem of the same scale with 'Software', and industry that is barely 50 years old and which according to the Standish Group's annual 'Chaos Report' still has >80% failure rate for 'ordinary' scale projects, let alone the mammoth that we are hunting.

Nigel --- http://foxonsoftware.blogspot.com/

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36

Chaos

30 May 08 16:23

Regarding the comment above, I have always enjoyed the slogan

"The possibilities are infinite"

Semantically "Infinity" is by definition "chaos" and/or "chaotic" as infinity has no defined and limited order

So why would a decent company accept that its slogan implies: "Fujitsu - the possiblities are Chaotic".....

Or is this what we've got delivered to date by Fujitsu?

The Truth is out there somewhere

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37

The whole project is based on a falacy anyway

30 May 08 22:27

By all accounts this multi billion pound total fiasco was based on the misconception that someone from say Newcastle could be admitted unconscious into a Hospital in say Cornwall and the patients medical records would be needed before any life saving treatment could begin... did any one ask a doctor ?

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38

Scared by Number 34

cpoee1@yahoo.com

02 Jun 08 02:35

The editors of this complete and detailed e-health news and the lads who read and comment should not be intimidated by comment 34. The truth should be known and you and your readers provide it to protect patients from risks of these dysfunctional systems.

Clearly my friends, these issues could have substantial impact on shareholder and executive net worth of these companies whose shares are traded in the US and they are required to report these material events to the American Securities and Exchange Commission. Those who wrote 22 and 34 appear to know this.

The truth must be known and you should not allow it to be suppressed by intimidation. Freedom of the press, as they say. For truth about health technology dysfunction in other parts of the world, browse health care renewal hcrenewal.blogspot.com (edited by a professor of informatics) check out seedie and extormity on this sight for some relevant comedy.

Cepi Oui

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39

We do things differently over here

03 Jun 08 10:56

Did France have a truly national programme for IT? I don't think so! What's more, why does the English programme have to fail because the French one failed?

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40

Response to no 37

03 Jun 08 11:03

I must assume that this poster is a doctor. Anyone who cannot see the advantages of having an even halfway joined up health IT system is possibly missing the message here. That's sad. People do get admitted to hospital off their own patches all the time and it can save significant efforts if health professionals can access a record with ease instead of relying on garbled histories from patients or relatives. Fallacy - I don't think so! The premise is good, just because the delivery is less so doesn't mean that it can't work.

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41

imperfect memory of PACS

03 Jun 08 12:08

Right back up at response 10, it was suggested that FJA did a good job on PACS.

No I don't believe they did (for the NHS anyhow). GE did a solid job, implementing their standard PACS product, HSS did a more remarkable job in scaling up their RIS system, and the NHS had to accept a number of compromises as a result (eg long-winded naming conventions rather than inferring site from separate fields).

I think that the FJA programme manager did a reasonable job forcing the programme along (and appeared to disappear when criticising the poor service delivery), but FJA (and CfH) have failed to deliver the joined up vision, with any meaningful access to the cluster archive, smartcard access, and most of all, the financial overhead of FJA's involvement scuppered the savings the NHS should have made on use of film. No wonder they appear to want to keep that part of the contract.

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42

Re: Post 38

03 Jun 08 16:09

"...the lads who read and comment..." Lads? Remind me which century we are in please. You may be surprised to learn that there are some 'lasses' who also read and comment on this site. Some of them even work on the national programme - whatever next!

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43

In Response to poster 40 (from my post at 37)

03 Jun 08 17:57

Whilst we mustn't treat this as a message board, I wanted to reply that I generally agree with your comments; but ask yourself, are the clinical imperatives for these NPfIT/CfH solutions really worth £13 Billion (in reality and judging by past and current performance, they are likely to cost far more than this) when most of us believe that this money could be put to far better and more urgent NHS use. We are intending this enormous sum of money to be used to develop new PAS/EPR solutions, when we all know that perfectly good, existing, NHS proven solutions are already out there. We ought to provide the suppliers with a specification for information interoperability, not prescribe new, untried and costly solutions. When are the Government going to call a halt to this madness?

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44

Fallacies & Fujitsu

03 Jun 08 18:47

"Fallacy - I don't think so! The premise is good, just because the delivery is less so doesn't mean that it can't work."

A fallacy is an error of logic. The logical error on which the CRS based is that a single national system can be universally accessible, entirely secure, fully updated, fully integrated and available in real-time under all circumstances and work in a cost-effective manner. This is not something that is difficult in practice; it is impossible in principle. That is the fallacy. Fujitsu has finally seen this and walked. I applaud their eventual honesty. The others will follow, simply because they too will gradually realise that there is no real alternative. No company can sustain a contract to achieve the impossible, let alone deliver it according to political deadlines. The question for CfH is how much of the original concept they will have to ditch in order to reduce the scope of the project to something which is reasonable and which the next government will be willing to continue funding.

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45

Such a lot of experts then!

sue.wilson@swbh.nhs.uk

03 Jun 08 20:53

I think it is such a shame that it had to come to such a drastic end for the 2nd LSP. Surely something could have been done to avoid this sad sorry state of affairs. There are no winners, only losers.

I wonder though when I read the many comments on this article, how many have actually implemented an electronic patient or health record? So many experts it would seem.

I think if some of you had you would recognise Cerner Millennium for the advanced clinical system (EHR) it is.I remain unashamedly a huge fan of this system and I do have some experience with EPRs/EHRs. I know which system has always been the easiest to obtain "clinical" buy-in.

Personally, the issues with the PAS elements are far over-shadowing what actually is a very successful EHR.

I do wonder about all of this though. "Give decisions back to local level". Well under Information for Health we had those decisions and I don't recall it was much better then in terms of progress. 35% of all acute Trusts were supposed to be at level 3 by December 2005. That wouldn't have been achieved otherwise more Trusts would have been well into their PFI procurement phase when it was all stopped in 2003.Nope, don't think so.

And are we all ready for the NCRS? Readers comments, GPs, Acute Trusts,etc do not seem to reflect environments where integrated care is enabled by integrated systems. We still see everything in organisational or professional silos.

I think the problem is that the NCRS is really "Utopia" and to achieve that requires such transformational change across LHCs and I don't think the vast majority are anywhere ready for that.

If you had all the functionality identified in the OBS today, would you be in a position to implement it or merely scratch the surface?

I think sometimes before we moan at local level, oh and I do too, we ought to take a close look at what we should be doing ourselves.

Personally, I feel that when the NCRs was launched, what was omitted was a roadmap and real gap analysis of how we would all get to "Utopia". It certainly wasn't a case of "One size fits all"

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46

Re: Such a lot of experts...

04 Jun 08 09:57

I suppose the other question that might be asked is "how many of the posters to this thread have ever treated a patient and made decisions based on health records, paper or electronic?" It's always suspicous when the "implementers" are enthusiastic and yet there are concerns being voiced by end users.

Picking up on another point - knowing the amount now being spent on NPfIT, would anybody expect anything much to have happened in terms of progress towards Level 3 prior to 2003 given the level of available funding at that time?

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47

Better solutions are available.....

04 Jun 08 11:10

I was closely involved in design work on the Critical Care solution from Cerner as an NHS clinician.

IMHO Millennium simply did not match up to the best available DCRs available for ICUs from other suppliers.

Major deficencies in the Cerner functionality were flagged, but due to the rigidity of the contract and the monolithic structures running the programme, nothing could be changed.

I always felt that the driver for the whole project was not patient safety or improving care, but improved ability to track and audit performance.

I am hoping that the South will now be able to purchase 3rd party solutions via the CfH project. I personally would not recommend Millenium to my own trust as it has inferior functionality to our current system thats been in place since 2002.

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48

Blame Culture

04 Jun 08 11:50

I have read the story and the comments with interest. I have been on both sides of the fence(clinical/IT/management) in various regions of the world so I guess I can comment with some authority. As to the vision about a patient from Newcastle being treated in Cornwall, it was just that a vision, something to work towards. As rightly pointed out by a fair few commentators, the benefits of an electronic health record are much more than just that vision. Has any one looked at gaining operational efficiencies, better patient experience or better user experience? As to the £13 billion cost- why think of IT as a wasteful expenditure compared to 'delivering' real service to the patients? Annual NHS budget is close to £100 billion, so £13 billion (the total cost of the programme including the NHS costs) comes to a mere 1% per year if you count the cost over ten years! Also ask a relative or a patient what is the value of a life saved by availability of accurate information - and you will not be able to put a number against it. Now multiply that by the 'n' number of lives saved and mishaps averted - and work out the cost per incident - is £13 Billion over ten years (for a system which will last for further ten years) too much to pay? As to the reason for failure, the trouble is no one seized upon the opportunity to transform the service. Most people wanted a like for like system with much more functionality at rock bottom prices! Most of the country and that includes clinicians, managers, the suppliers, the press and politicians saw it as an 'IT' project. Look at the headlines - ' multi billion pound IT project'. Have you seen any headline that says ' transformation project' ? No wonder the project is not keeping up the pace that it should have. Also most often you will find people sitting and criticising an IT solution, the supplier or the software provider. I have yet to see enough people coming up with constructive suggestions of how to make the programme work! (apart from give it out locally, get rid of the LSPs, give us our local procurrement powers). Is NHS really capable of a smooth, cost effective, efficient, timely and transformational procurrement? Look at the practice based commissioning scene! Every one wants to be a world class commissioner but wants people with experience of having run commissioning services for the past five years! What is the point in doing the things the old way if you want to go somewhere new? To have ground breaking innovations, one needs fresh thinking, a different perspective not the same old same old people dyed in the wool, wanting to run the system as before albeit under a new name! If we want the system to be smoothly implemented and avoid any more mishaps, we all need to realise the positive impact that we can make to the programme. It is not just a matter of ticking the boxes on requirements documentation and the Prince 2 project plan! It is more about changing our mindset. (I do not have any interest in any LSP or their software providers. I do not have any material interest in any NHS organisation either)

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49

Re Post 45 by sue.wilson@swbh.nhs.uk

04 Jun 08 13:24

Whilst I have sympathy with many of Sue's comments made about the pre-NPfIT world I can't entirely agree.

In 2003 there were many procurements for EPR systems that were summarily stopped by Department of Health including Shires, pan-Bristol, Black Country to name but a few.

As someone working on Shires, five years on I think that by now it would have delivered more for the Trusts than we have seen so far from SPfIT which is a lot of money and good-will down the drain and still using the same old systems but they are five years older.

In fact it is almost exactly five years to the day since Shires was stopped - and we haven't moved on at all.

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50

re comment 48: what changes wanted?

maryhawking@tigers.demon.co.uk

05 Jun 08 11:10

I agree to some extent - the NPfIT was always supposed to produce changes in ways of working. Can anyone tell me what these changes were intended to be, and the EBM (Evidence Based Management) goals they were supposed to serve? I'm a GP: my ways of working changed significantly when we became computerised in 1992 - we had wanted to but practice circumstances delayed acquisition - and Kenneth Clarke's introduction of targets for cytology and childhood immunisations - try running *that* on paper! - made it essential.. In my experience all sectors in the NHS are changing ways of working at an ever-increasing pace. Was NPfIT supposed to produce specific change, or be like pick-up sticks? Throw them in the air and see what happens?

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51

Shires & IDX

05 Jun 08 11:21

I think you are misguided re Shires - in that the product selected was IDX - which was dropped by both the London and Southern clusters. This was based on fedback from the service on the product and lack of visible signs of any development. What makes you so certain that it would have been different under a Shires consortium arrangement?

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52

Shires & IDX

bob.curtis@glos.nhs.uk

05 Jun 08 13:39

At least we would have found out well before now and had time to do something about it!

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53

IDX & Shires

05 Jun 08 18:01

The difference that the Shires would have experienced with IDX was that they would have had a direct working relationship with the system supplier. Enterprise EPRs require a closely worked program of development, configuration and implementation between the company’s consultants and the client’s staff. I am certain this is true of all enterprise EPR system suppliers, it can work no other way. Healthcare provision is far too complex and variable to deliver ‘one size fits all’ for enterprise EPR solutions.

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54

Newcastle and Cornwall

06 Jun 08 10:03

Surely the point about Newcastle and Cornwall is that the statement was the best public justification of the national programme that Frank Dobson, then the SoS for Health could come up with (I may be wrong, but I think he said Penzance, not Cornwall).

The frightening thing is that the Newcastle/Penzance paradigm might been the totality of the political undertanding and that on such was built the whole sorry and wasteful edifice of the national programme.

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55

IDX not dropped in London

06 Jun 08 10:05

The IDX product was not dropped by BT as is often repeated here.

IDX was purchased by GE Healthcare who then walked away from the BT contract.

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56

Great Mantra

06 Jun 08 12:19

One size fits all - ie I want to keep using my non-standard methods of working and notations that I, the acknowledged expert in the whole of Pratts Bottom/Gravesend etc, have invented in the face of national international standards designed to allow best practice. What other part of society is allowed to take this approach?

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57

No difference really.

06 Jun 08 12:31

My experiences historically seem to indicate that there isn't much difference to IT progress if suppliers are managed through a National Enterprise Contract or through a local contract.

Take the GP System Suppliers for example (EMIS, Torex, InPS, etc.);

Consider the year 2000 when 100 or so IT Managers from Health Authorities called them up on a weekly basis to demand progress on GPNet.

Or consider 2003 when 350 or so PCT IT Managers called them on a weekly basis to demand progress on PMIP.

And not forgetting 2007 when 1 CfH manager called them on a weekly basis to demand progress on EPS 1.

Three historic snapshots in which the outcome was exactly the same - i.e. the suppliers still completed the requirements in their own time with the resources they had available to them - not necessarily to the timescales imposed on them.

Having been an IT manager through these three scenarions, the only difference the CfH scenario has made is that it is no longer my responsibility to chase the supplier on a weekly basis to demand progress - have to admit that as it's no longer my responsibility, this does make it somewhat easier for me to blame CfH for delays when completing board reports on progress...

Being responsible did make it seem like I was more in control, but looking back, I guess I wasn't really. then like now, it's the suppliers who seem to be in control of our destiny.

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58

re: IDX not dropped in London

06 Jun 08 12:48

I would endorse the comment of poster number 55 and add that the GE (nee IDX Carecast) deployments seems to be progressing well in the UC/Royal Free group of hospitals (unencumbered of course by LSP involvement).

This adds additional weight to the case that direct relationships between software vendors suppliers and Trusts enables constructive progress.

(post edited by EHI)

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59

re: Great Mantra

06 Jun 08 13:17

Stalinism is so passé. It does not work, is massively inefficient and strangles innovation and progress.

What matters are outcomes and outputs. If a local clinician provides a service that has the desired outcomes and outputs it does not matter a whit if he uses his own system of notation providing it maps, when required, to the national and international standards. His system of notation may be the next big step forward in his speciality.

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60

Re: Shires & IDX Post 51

06 Jun 08 16:15

I'd echo the comments from Post 52 and 53. I am not certain that IDX would have been OK but the fundamental difference with Shires and other EPR procurements was that they recognised that there was no product out there that met the NHS's needs so before delpoying there was an extended period of development with the NHS. If instead of trying to implement a system immediately, Fujitsu and IDX or Cerner had spent that time we might have got an implementable solution. Instead the contract drove them to roll out an off-the-shelf package into Trusts almost unaltered. I strongly believe that the implementation model was more flawed than any of the products. All of them are flawed but most of them could be developed WITH the NHS to meet its needs. And finally to agree with Bob Curtis, if the products didn't work we'd probably have found out in less than five years!

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61

Shires - rose coloured spectacles

06 Jun 08 19:49

Shires was not so great - it started as a PAS replacement, and the specification became the NCRS one, lacking in detail and common sense. But the biggest weakness was that the money was never there, and to justify the exessive price tag, extreme pressure was levied to create benefits for the business case that were dubious at best.

Did people involved at the centre let Shires run until the price was known as an unreal benchmark, but with little intention of ever funding it? For me, this was an early part of the whole NPfIT debacle.

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62

IDX and Cerner

06 Jun 08 21:45

Lets be a bit Objective here, there is no single product that meets all of the Connecting for Health requirements. Some are very good in particular areas and poor in others. IDX was a very stable product but development was so slow Fujitsu and BT had to abandon it. According to Cerner their software ticked 95% of the contractual boxes and gave something that could be rolled out almost immediately but needed some customising because it was written for the American health market model. With later releases providing the missing 5% and expanding what was there.

Each trust has its own way of working but with the right solution there is much sense in a common software base and a common set of shared good practice. It would make it easier to share expertise and make moving between hospitals easier for staff as they would know the processes in advance. Yes it is a bit Big brother but overall standardisation can bring huge benefits as long as there is still room to specialise. There is a greater chance with shared good practice of bringing all Trusts up to the levels of excellence at present restricted to a few. Of course this would require more than a software set but a GOOD set of standard processes defined by the software could be a starting point.

Allowing large contracts does mean trying a one size fits all but brings with it the heavyweight benefits of full data centre Disaster recovery services and high end solutions beyond the budget of a Trust. Swings and roundabouts.

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63

Interim clinical solution needed.

08 Jun 08 10:36

What acute trusts urgently need is a "basic" clinical information system to get us started on the road to a more complex system. This basic system would include: demographic details including weight/height/BSA, emergency contacts, scheduling, coded allergy/sensitivity/adverse reaction details, active medical conditions, significant inactive medical conditions, clinical noting, care plan, vitals monitoring, bi-directional HL7v3 interfaces to Pathology, Pharmacy and Radiology systems, ability to create a discharge letter with discharge medications, ability to prescribe for outpatients, built in/intuative coding software and a flexible SQL reporter. Surely it can't be THAT difficult?

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64

The Great Mantra (part III)

09 Jun 08 09:19

Legitimate resaons why one size does not fit all:

1) Physical Space may/may not allow co-location of support services affecting the ability of services to be delivered seemlessly

2) Resource constraints may/may not allow patients to be seen at the same time

3) Differences in physical/resource configuration in (for example)Theatres/Outpatients affect movements of patients

4) Different patient groups - especially in specialist units such as Paeds and Eyes - have different needs

5) The cost of changing processes so they are the same as the place down the road far outways any possible (and certainly any proven) benefit to patients

6) ....oh why bother going on? People who have worked in the Health Service already know this stuff, and I have better things to do than to explain it all again to yet another opinionated management consualtant