Liverpool iPM glitch overbooks some clinics

28 Jul 2008

Problems with a new iSoft iPM patient administration system left some patients at the Royal Liverpool and Broadgreen University Hospitals NHS Trust arriving for appointments that staff could no longer find records of having been made.

The problems appear to relate issues with migrating appointment data from the trust’s old PAS system leading to appointment details not appearing on the new iSoft PAS.

The system, which was launched by local service provider Computer Sciences Corporation (CSC) on 7 July, saw cancelled appointments not appearing on the system, resulting in clerks overbooking outpatient clinics, including those for orthopaedics.

One frustrated relative told E-Health Insider how his parent had shown up to outpatients for a blood test ahead of an operation the hospital had subsequently moved, without rescheduling the initial blood test appointment. “People were turning up in out patients with letters for appointments the hospital had no record of.”

Problems affected both the Royal Liverpool and the Broadgreen hospital sites. A spokesperson said these were due to “a few glitches which are to be expected with a new system.”

The spokesperson added: “We believe this has only affected a handful of people, and we have technical experts investigating and rectifying the problems.”

Records of about 4m patients have been transferred on to the new PAS and over 4,000 staff have been through an extensive training programme.

Alison Dailly, the trust’s director of information, said: “The new system will be a big improvement for us – it records activity in our hospitals in real time which means we can give patients up-to-date information and respond to their enquiries much more accurately. It also means that we can reduce waits because it works with other system we have in place to reduce paperwork and delays in transferring patient details between departments.”

She added: “Since 7 July we have seen 6,448 patients in Accident and Emergency, 24,753 patients in out patients and have had 3,560 admissions. There have been some teething problems with a handful of outpatient clinic appointments being overbooked. The trust is currently working to ensure that patients continue to receive the best possible care and we are delighted that overall our services are running well.”

Reader's Comments

Phew

28 Jul 08 09:18

e-health-insider news items have become a gutter inspector reports. Come on, if you dig all the PAS implementations that have gone live pre-cfh and all the implmentations that are going outside cfh currently have the same problems. Dont demean the programme just because some trust personnel are not interested in it nor they understand it. The economics of maintaing instances of apps in 101 data centres is lesser compared to maintaining in 2 data centres. Simple economics which the so called "experts" in trusts will never understand.

Who else?

28 Jul 08 14:08

Then again, if it wasn't for eHealth Insider, these kind of stories would never appear. How many millions is the project costing? I'd expect something as fundemental as recalling appointments as an important part of the system - a core requirement. I'm glad eHealth Insider reports on these issues and I look forward to the day when they can show us value for money stories.

Phew - what nonsense !

29 Jul 08 00:18

Missing the point here Phew, the economics stack up because of the 101 data centres are not being replaced or downsized. The NPfIT model is at best duplicating the existing IT base. Also Phew, the problems described here are well known in the iPM product but due to support model now in place, Trusts are not aware of issues as the data is locked away in a datacentre inaccesible to Trust staff who can manage these faults. This disappearing act of data has frequently been reported by users of iPM and previously reported on e-health-insider. CSC don't appear to be learning so the economics are actually worse that the previous Phew (CfH) statement tries to justify.

IPM replacement

29 Jul 08 13:00

These problems will all disappear when Lorenzo is available - given that it has significantly less functionality than IPM allegedly !!

Data migration issue?

29 Jul 08 16:14

Surely this is a simple data migration issue - with 4m patients a small percentage error is to be expected but will affect hundreds of patients.

In the past the NHS has been very good at covering such glitches up. In my own Trust, pre-iPM, patients were forever turning up with appointment letters that no-one had a record of usually because a clerk had forgotten to put the details of the letter onto PAS. At least now the patient letters are generated by iPM there is less risk of this happening.

Congrats to everyone at Royal Liverpool - if these are the only problems you have had post go-live it sounds like a pretty good migration.

Only people who have been through a major NHS migration and go-live will understand the complexities of the situation. This isn't banking or other CRM with a limited number of transaction types and a small number of business processes!

Planning for migration glitches

maryhawking@tigers.demon.co.uk

31 Jul 08 21:55

If we take it as a given that in every change of system there are going to be glitches like this, why isn't there a recognised backup organisational system for managing it? In general practice, if we know the system will be - or is at risk of being - down, in my practice we would put the appointments for the next x days on a backup floppy (we do that anyway just in case), and import the full records of patients who already have appointments booked into a Word file or series of files.

It seems that a large number of acute trusts have had problems with appointments during system migration - and it could well be that this is inevitable - so why no published and accessible plans for managing this?

Lessons learned

salsmith766@msn.com

01 Aug 08 10:32

I endorse the comments about data migration and having backup plans - however, I worked on an iPM go-live two years ago in the NWWM cluster, and they had exactly the same problem with outpatients turning up of whom they had no record. I am pretty unimpressed that the lessons of this were not learnt and have not been applied to subsequent go-lives.

Migration Myth

04 Aug 08 14:39

In my 25 year IM&T career I have been personally involved in many system migrations, including hospital PAS systems and the one thing I have never had problems with is losing data. When you send data from one system to another you create a control list from the sender and a control list from the recipient and then you carry out, what we called in the old days, a reconciliation. In all those years I never failed to reconcile a system 100% and we never had records going 'missing'. Anyone who says that a degree of error is inevitable is either knowingly misleading you for a reason or doesnt know what they are talking about. Computers don’t accidentally lose records, there is a logic problem. If you test properly, you will always find it. You use old fashioned check sums and totalling and you do range checks and you reconcile 100% of the transferred data. To suggest that modern computers have a problem because of the lareg number of records is laughable nonsense. Computers have no problem reconciling billions of records, its just a matter of running the programme and waiting. As long as you have enough electricity and enough time (and you are using UNIX :-) you can reconcile every record on the planet on a PC.

What happened here is that insufficient resources and time were applied to implementing the system. So the people involved would not have time to do the necessary checks. A problem which is ingrained in the national programme. Time and time again Trusts are given access to software far to late to redesign business process and the systems they are given do not have adequate data mining and reporting facilities to support good system reconciliation. Often there is no training or test system at all, so you are practicing on the live data. The elephant in the room is the implementation cost of a national system and its an elephant that will squash the programme in due course.

Fact or Fiction?

04 Aug 08 17:13

Would I be right in assuming that the previous commentator was involved in the project given the first sentence of the second paragraph....???

My understanding of 'what happened' is that fitting a square into a triangle isn't easy. Choices have to be made that best allow an organisation to achieve the goal they have been given (be that through choice or otherwise) and sometimes compromises have to be made.

At the same time it is important to understand the distinct but often blurred differences between a migration, a new system implementation and business process management....something lost on the initial reportage.

For an organisation of this size to successfully go-live on any system is an achievement in itself and appreciation of the bigger picture is needed.....but that doesn't make for a good story does it.....?

So a patient turns up without an appointment. Yes its a problem, yes its something that needs dealing with and no its not desirable, but given the millions of records involved its easy to lose focus.