Derbyshire scraps Lorenzo plans

Tags: A East Midlands emergency Information iS Lorenzo Mental Health Strand Technology

06 Aug 2009

Derbyshire Mental Health Services NHS Trust has abandoned plans to implement Lorenzo, following problems with its development.

E-Health Insider understands the trust wants to see problems with the development of the iSoft 'strategic' electronic patient record system resolved before implementing it.

Earlier this year, NHS East Midlands published an IM&T update saying that Derbyshire Mental Health Services NHS Trust had become an early adopter and was working to deploy Release 2.0 care management, including day care management.

The document also identified Kettering General Hospital NHS Trust as implementing Release 2.0 care management, including emergency care.

The papers states: “These are scheduled for deployment in 2010 and both organisations are actively engaged in their projects as part of respective early adopter cohorts.”

However, EHI has learned that Derbyshire will scrap these plans and instead continue using one its existing system, CareNotes, at least until 2012. CareNotes is an electronic patient record system specifically designed for mental health trusts by Strand Technology.

A trust spokesperson told EHI: “The trust board agreed in November 2008 to adopt Lorenzo as the trust’s single clinical information system.

"We remain committed to Lorenzo in the long term and believe it will provide an excellent long-term solution, but at present there are a number of uncertainties with the timescale for delivery.

“In the interim, the trust will extend the use of one of its existing systems and adopt Lorenzo in the future, by which time we will have had the opportunity to see the system in operation at other trusts.”

Links: Strand Technology

iSoft

Sarah Bruce

Three more early adopters for Lorenzo (19 May 2009) (9)

Readers Comments

So much for CFH promises

mr.acute.cio@live.co.uk

06 Aug 09 10:01

Is this another nail in Lorenzo or a pragmatic approach to a difficult situation.

It would be so very easy, but pointless, to rubbish Lorenzo, but am sure it will be a very good system in its own time. It would also be so very easy to criticise CFH and CSC for poor specification, project development and planning, but we are where we are, no one above Trust level is going to be held accountable, so that too would be pointless.

But what really is annoying is the legacy of bullying by SHA’s, CFH, CSC and some PCTs, to propose or accept patently unrealistic product delivery assurances and schedules. These people, in a position of power but with no accountability, have, over the past 4 years inflicted damaging inertia in the field of NHS IT, at a time when we should be powering ahead with modern, widely accessible Electronic patients records and advanced clinical support systems. Instead what are we doing- waiting for a PAS!

I know the call is to revert back to local systems and decisions, but the original objectves of NPfIT are as right now as they were then. If we debase this strategy through poor leadership, if we revert to service tribalism this will set the NHS back years.

It does make you wonder.

06 Aug 09 13:58

Lorenzo why?

You have a system that works in RiO and what do you pick - one that is not written for this environment (yet).

From what I can work out Lorenzo is sorting out the Acute setting first, this is what they should be doing.

The decision makers at this Trust must be completely bonkers! I expect they have purchased tractors for ambulances!!!

Correcting the last post

david.hannam@strandtechnology.co.uk

06 Aug 09 18:51

I'm David, one of the founders of Strand Technology. This is not a Sales pitch but I have to take issue with the poster of the second comment as I believe he/ she is speaking from a position of ignorance. Strand has worked with the Trust for over 10 years, over 100 members of their staff had input into the design and implementation of CareNotes. CareNotes is designed for the CfH environment which is why we are a supplier named in the ASCC framework contract and will achieve spine and PDS compliance in February 2010. To say that the Trust is 'bonkers' is insulting to the trust and demonstrates a lack of knowledge on the part of the poster.

lorenzo

06 Aug 09 21:11

To the comment above this - completely unfounded statements with no factual comments there. There is an area specifically for Mental Health from what I understand.

I think perhaps before you critise Derbyshire, I think you should first understand the reasoning behind making the decision to go with Lorenzo. I don't know the answer to that question, however it's possible it's the same as others;

Why buy a new product, which would in terms of cost, add a large amount to the budget of the project right from word go?

Add the cost of that along with new IT equipment, staff costs etc - would you not then be critising a Trust for spending more of taxpayers money on 'another' IT system when a national system is already being developed?

It sounds like Derbyshire is making a sensible decision overall if they have concerns over issues with the software - which to its defence, any new system will have.

I agree entirely with the first poster. Alot of pressure is on the suppliers right now to deliver and the last two articles on here imply that a end product is not yet completely ready to deliver, so why are Trusts heavily investing and preparing to embark on an IT Project? CfH? SHAs? DoH? Must be from somewhere!!

The real problem with Lorenzo!

08 Aug 09 08:42

The Lorenzo concept is outstanding and in line with the EPR concept could be revoluntionary to an NHS which at present is disparate and can sometimes inhibit patient care due to the standalone tendancies of many trusts.

The problem is two fold, the vendor (iSOFT) themselves and too many cooks from a CfH & CSC.

iSOFT have spent a lot of money employing "advisors" to re-develop the Lorenzo framework, even though its concept was quite well developed and plausible four years ago. This is a reaction to constant swipes at the LSPs and Vendors from CfH the trusts and of course constant changes of scope too.

The people employed have been given tighter and tighter deadlines to develop "designs" and each area of care has not been given enough time to work alongside related teams. Why? Because development is still taking place in india as theoretically it is cheaper. However the entire process of sending a document to an unfortunate programmer who's first language is not english and certainley is not "healthcare" english, the programmer making mistakes, scope creep and a whole host of other things causes massive timescale problems.

Maybe this is a political suggestion but, why don't iSOFT employ some UK based programmers who know C# & asp.net but also know about the UK healthspace, can work with the designers and CfH/CSC and actually deploy a product that works? With this solution we would have had a viable piece of software now the costs would be a lot lower.

I am sure there are many people in the UK who have such experience and now the bubble has burst will proably takes lower wages than before. No I am not an out of work programmer who needs a job but a Software Consultant who is sick of being given software which does not meet the design requirements, all in the name of "cost savings".

re: The real problem with Lorenzo!

10 Aug 09 11:00

>>iSOFT have spent a lot of money employing "advisors" to re-develop the Lorenzo framework, even though its concept was quite well developed and plausible four years ago.<<

So the concept was well developed by 2005. That's mighty comforting but how does this fit with software being stated to be ready for delivery for live clinical use to the NHS by Autumn 2004?

Was this stupidity or over-optimism?

Who's bonkers?

luckylorna@fsmail.net

10 Aug 09 16:19

Poster number 2: I'm not quite sure what your talking about:

“You have a system that works in Rio”. Have you not read the recent London carnival on hold for RiO article in EHI?

“and what do you pick - one that is not written for this environment (yet)”. Has CareNotes not always been a dedicated mental health solution? A brief look at the statement on the home page (www.strandtechnology.co.uk) suggests as much...

“The decision makers at this Trust must be completely bonkers!”. From what I hear in the mental health arena these days the choice is essentially between two systems: Rio and CareNotes. If they already have one of the two leading systems in place and it works for them then they’d be downright certifiable to take anything else. That is, of course, until the full majesty of Lorenzo is eventually realised for mental health Trusts. It’s only four years late. Surely we won’t have to wait for more than another two? Although from John Hoeksma’s recent article, Insider View: Jon Hoeksma, this wouldn't be a huge surprise...

Foresight?

11 Aug 09 00:04

people said that Noah was bonkers when he built the Ark, but when the Trusts who are still waitingfor Lorenzo in two years time start drowning in the cuts of the next settlement, i suspect that it will be Derbyshire who have the last laugh.

You have a system that works in RiO ?!?!

nhstechie@btinternet.com

11 Aug 09 07:45

WRONG!

You may have two systems that work in RIO - Community AND Mental Health - but you don't have a system!

It would be "bonkers" to move from a single Trust-wide clinical system (irrespective of the supplier) to two separate systems which are incapable of being interfaced - wouldn't it?

Like most MH Trusts, Derbyshire consists of inpatient and Community services at a ratio of roughly 1:2. Patients are constantly moving from one to the other, depending on the severity of theiir condition and current level of recovery.

A Few Points that need correcting

11 Aug 09 14:19

Derbyshire Mental Health's IM&T Strategy is a published document and there are a number of IT Systems within the Trust, Care Notes is one of a string of other systems as well as the current fore runner to Lorenzo, PiMS (sorry iPM). More stick for RiO, I note, together with a few inaccurate comments. RiO is a single product that can be customised for mental health, community and social services. In London it has been customised for Mental Health Trusts and Primary Care Trust Provider Services by LPfIT. Surely NHStechie knows that Mental Health Trusts and PCTs are separate organisations? Through the Shared Patient Record and the Spine they will be joined together to include acute hospitals and GPs - ground breaking stuff. We all know about the current technical issues in London and these are being addressed thoroughly by BT & CSE Healthcare but isn't the real issue Derbyshire Mental Health's business decison not to be reliant on vapourware for its future? Is'nt it about time others made the same pragmatic decision??

Re: A Few Points that need correcting

12 Aug 09 13:06

Strangely enough I am aware that PCTs and Mental Health Trusts are different organisations and that patient pathways more often than not cross these organisational boundaries more than once in a lifetime. However, having read the detailed functional descriptions of both Rio Mental Health and Community systems available from http://www.london.nhs.uk/webfiles/lpfit%20documents/service%20management/Services_RIO/RiO%204.7.0/MH%20Briefing%20doc.doc and ... /RiO_CH_Briefing_Document_V4.7-0.0.2.doc and having listened attentively to an excellent and well balanced evaluation of Rio at HC2009 by a senior clinician from St Georges and SW London my impression is that Rio doesn't offer the full functionality required to support CMHTs or other community-based MH or LD teams.

Rio Mental Health looks ideal for Adult MH Inpatient services (though it doesn't currently support the Mental Capacity Act) but my impression is that to enable the accurate reporting of Community Contacts, staff within a CMHT would need to access the Rio Primary Care System, or revert to another electronic or paper-based system in order to collate this information.

Happy to be corrected if this is a false impression and if Rio MH does support the accurate recording of Community Contacts.

I completely agree with the previous poster's evaluation of vapourware and the need for a pragmatic approach - which I believe colleagues in Derbyshire have taken!

EPR = Noah’s Ark?

13 Aug 09 20:57

I’m assuming that poster number 8 is referring to people like Wanless and Darzi’s views that the NHS should be looking to IT to help it make the productivity increases it will need to cope with the impending cuts?

Whilst the mantra’s of ‘quality’ and ‘safety’ seem fair reasons for pushing forward with the type of modernization envisaged under the National Programme, can this type of system really make much of a difference to a Trust’s bottom line? It’s all very well waxing lyrical about IT bailing out the NHS in the chilly times ahead, however, surely how this might work should be spelled out before we throw more good money after bad?

And on another note, some interesting links in post 11. Doesn’t ‘commercial in confidence” mean anything anymore?! Lol.

Can Trusts act in time?

14 Aug 09 17:52

It is estimated that a good electronic Care Record System can save a qualified Mental Health nurse at least an hour a day on paperwork and admin. So, for a Trust with 500 qualified nurses with an average salary of £29,700pa this could save nearly £2m of nurses time per year (i.e.114,000 hours) that could be redirected to patient care.

That’s before we even get to the provision of regular and accurate performance data to ensure the Trust meets targets and gets paid, and the ability to analyse the data to identify areas for efficiency savings. I’m sure someone with a business intelligence background will be able to give us some example sums on this one...

In theory the move from paper to electronic systems really does seem to be a no brainer, provided that a quality solution is procured. The question is, how many Trusts will be able to do a Derbyshire and get a system in place in time for the funding cuts ahead? Or will CfH continue to stall them until the election so Labour can attempt to save face, and until they lose the budget they may currently have to get a new system in?

Recipe for disaster?

14 Aug 09 18:00

Re: Post 7 - In theory a fair point but given the problems with even an establised solution (i.e. Rio) in London, do you not think it would be somewhat cavalier of CSC to take a risk on rolling out a brand new product across the whole NME Cluster? Surely a recipe for disaster if ever I saw one!!