Industry experts call for acute systems of choice

Tags: A ASCC BT Cerner CfH Choice CSC Fujitsu iS London LSP NPfIT South

29 May 2008

A range of politicians, industry analysts and experts have urged NHS Connecting for Health to use Fujitsu’s exit from the National Programme for IT as an opportunity to introduce acute systems of choice, based on the ASCC catalogue.

Fujitsu on Wednesday had its £896m contract as local service provider in the South terminated, after a fruitless ten month contract re-set process.

Shadow health minister, Stephen O'Brien, said the departure of a second local service provider to NPfIT demonstrated “the government's attempts to ram through a top-down, centralised, one size fits all NHS supercomputer system have come crashing down. This is £12.7 billion of taxpayers' money now at risk.”

In a press statement, Connecting for Health, sought to stress continuity and business as usual: "Work has started immediately on planning the necessary arrangements [for change].”

Both CSC and BT told EHI they would if asked consider taking over the Fujitsu LSP deal

Richard Bacon MP, a member of the Commons public accounts committee, added: “It's time the Department of Health stopped forcing NHS trusts to wait for triple-decker buses that haven’t left the drawing board.

The MP called for buying decisions to be put back into the hands of NHS trusts. “The original approach of handing over monopolies to a handful of local service providers was never going to work and has been shown not to work”.

A series of industry analysts and experts recommended a return to local trust choice of systems, potentially through use of CfH’s recently completed Additional Supply Capability and Capacity (ASCC) framework catalogue, rather than handing the contract to an existing LSP.

Jonathan Edwards an analyst with Gartner, told EHI: “The immediate priority for CfH is to clarify the arrangements for the transition of services and to find a new way of stimulating adoption. Perhaps now is the time to look at restoring acute systems of choice.”

Tola Sargeant, an analyst at Ovum, cautioned against a straight handover of the Fujitsu LSP contract: “Of the two remaining LSPs, BT, the LSP for London which is also deploying Cerner’s software, would be the obvious candidate. However, BT has its hands rather full enough already with the London deployment and we’d urge NHS CFH to think twice before handing it the South as well.”

Sargeant urged CfH to explore the ASCC route: “Instead, NHS CFH may choose to use its new Additional Supply Capability and Capacity framework agreement for the procurement. The question is; do any of them ([lot 2 suppliers] really want the job?”

Another anonymous industry expert said CfH had three options: “The task in hand was not as clear cut as Fujitsu first thought. This begs the question of what happens next. Does CfH stick with forced choice of either Cerner or iSoft, or do they open up the ASCC lot 2 and provide trusts with choice? And what happens to all those members of staff employed just to work with Fujitsu and Cerner?”

Bacon also called for use of the framework contract: “NHS Connecting for Health had the sense to sign a contingency framework contract so that other suppliers could be let into the market. My hope now is that the Department of Health will make use of that contract to let hospital trusts buy from a range of suppliers.”

Sargeant concluded: “For the National Programme as a whole, this is yet more unwelcome news. It will inevitably put another major dent in public confidence in the Programme and it is hard to see how it will not lead to further delays. For Fujitsu - however you spin things - it is also a severe blow.”

Readers Comments

The ASCC is not ideal

29 May 08 22:41

I would agree that now is the perfect time to drop the idea of a single system delivering everything to all people. It was never going to work and lo and behold, it hasn't.

However, the requirements for gaining acceptance onto the ASCC lists was not based on the capability of the product but on financial and service capabilities of the applicant companies. There are many small but innovative suppliers of clinical systems that did not make the list simply because they were not deemed large enough or did not make enough profit from their existing customers. Clinical functionality did not enter into it at all.

Framework contracts are a good thing, as are standards for inter-operability and reporting, but that should not exclude local choice, which is the only way to satisfy the diversity of clinical practice.

ASCC was another major NHS (CfH) mistake

30 May 08 22:42

ASCC did not look at sucessful NHS implementations or functionality...we were told this was not what the NHS wanted. As the reply above commented the ASCC route would exclude many of the current successful PAS/EPR suppliers

Baby and the bathwater

02 Jun 08 10:42

In all the "told you so" which is now going on let us not forget the reason for the "ruthless standardisation". Acute Hospital systems cannot sit in isolation. They must share information between hospitals and between hospitals, community primary and mental health care. Don't forget how long it took to implement Pathology Messaging across the NHS. On set of messages for one aspect of health care took the best part of five years.

There is an awful lot of bathwater to be thrown out but don't forget the baby.

Follow the GP System of Choice

02 Jun 08 11:48

Top down approach, ignoring the users requirements and knowledge... it was destined to fail. Why not use the GP example?? The majority of the LSPs are the clinical providers who have developed the systems with the users input. The systems have matured over time and they have been able to add the NPfIT services (ETP, C&B) without losing their original functionality and flexibility. This is a sensible approach and should be the way forward for Acute and not forgetting Community service providers.

An occlusion, quick - put ASOC in it?

04 Jun 08 00:52

GPSOC has some credibility based on an enthousiastic GP user community and demonstrable clinical point of care functionality.

But ask a clinician in the acute sector which is their favoured clinincal system which handles not only patient registration, but order comms, clinial noting, clinical hand-overs, medication management including clinical decision support, transferrable longitudinal patient records, and which allows advanced clinical audit, reasonable access to query across datsets, integration with Radiology systems, and supports not "standards" but which demonstrably interacts with safe transfer or integration of clinical data between the 'ASOC' and other rich, clinical departmental systems via a trust integration engine, then we really would be cooking on gas.

(post edited by EHI)

SITLFOW

06 Jun 08 16:00

Point taken... acute's may require more scope and functions than GP systems, but the fact remains working with the users and the current systen suppliers who know the requirements has helped and not hindered the maturity of the GP systems.

There is never going to be a 1 system fits all, hence the importance of EMIS, In-Practice and the Synergy all having a healthy share of the GP market. Acute must have (none LSP's) systems (PAS) that previously met some of these requirements. A distributitive system allows integration and setting standards in data sets allows systems to be flexible in their approach as well as satisfy the idea of an NCRS. This may be years away, but only by working with the users in their environment will we ever move forward. Point taken that some of the NPfIT requirements (PACS) are new functions, but trying to build all the requirements and functions into 1 system is destined to fail.

ASCC no answer

06 Jun 08 20:23

The ASCC shortlist was another botch job from CfH conducted in a darkened room to military secrecy standards, including little reference to real world need, or rationale that they have been able to share with the NHS.

Procurement was never the problem pre-CfH, it was adequate funding that was not then pinched for the latest panic - reducing waiting lists, deep cleansing hospitals, overpaying GPs.

NHS IT suppliers have been deeply ravaged by the NPfIT hiatus. Those that have survived have not been developing their systems as one might hope, because their longterm prospects, and order books are constrained.

But if the small and innovative suppliers exist on ASCC, it is either an accident, or because they have doubled their price through some intermediary.

We could try the Open Source route. All that NHS intellectial property we have squandered on suppliers who have failed to deliver. We could upgrade to the open standards approach that South Africa is demanding for the developing world.