Cerner go-live at Newcastle delayed
03 Sep 2009
Newcastle Hospitals NHS Foundation Trust has decided to take additional time before going live with a big bang implementation of Cerner Millennium.
The system, which is being delivered by University of Pittsburgh Medical Centre (UPMC) outside the National Programme for IT in the NHS, had been due to go-live over the August Bank Holiday. Sources close to the project indicate that data migration has been challenging.
The trust told E-Health Insider that although technical completion had been reached, it had decided to take more time to ensure all the operational implications of the implementation were “understood”.
The trust says it now aims to go-live with the new system, which includes patient administration and advanced clinical functionality, across all its hospitals by the end of the calendar year. However, it says it will take more time if required.
David Allison, the trust’s business operations and development director, and the man responsible for the programme, said: “The trust reached technical completion by the end of August. But I wanted to be clear we understood operational implications of go-live.”
Allison added: “As far as I am concerned we are not working to a specific date but a quality standard.” He described the additional time being taken as a “necessary extra quality check” on Newcastle’s eRecord project.
“The eRecord project team’s focus has been on getting to technical implementation; but there is a big difference between a process you can go live with and one that will be a success.”
The trust has been working with its partners on a complex data migration, which is now said to be complete but which has not been without problems.
However, Allison said Newcastle also wanted to understand what impact the system might have on key operational processes. “I’m very keen to understand what the impact would be operationally for 18-week waits and Choose and Book.”
He stressed that these business critical areas offered very little margin for manoeuvre or error. “On 18-week waits there’s not a lot of flexibility.”
He said the experience of Royal Free and Barts and the London, which went live with NPfIT implementations of Cerner Millennium last year, showed the financial and operational problems that could result if such areas weren’t absolutely right.
“We’ve had to put a lot of effort into ensuring it [Cerner Millennium] supports the business processes of the NHS and ensuring the operational implications are understood,” Allison said.
He acknowledged, however, that with staff trained on the new system and data migrated there was an optimal period for a go-live after which “knowledge decay” would occur and a lot of repeat training and preparation would be required.
Asked when he would be recommending to the board that the full go-live should occur, Allison said: “In this calendar year is when is in my head.” But he added: “If we find there is a major showstopper we could take more time.”
He added: “What becomes clear as you start these types of project is that they start being seen as an IT programme. But it becomes clear this us about changing business processes and getting people supported through use of technology.”
Newcastle is one of the largest foundation trusts in the country, with 2,000 beds across a number of sites including the Royal Victoria Infirmary, Freeman Hospital, and Newcastle General Hospital. The planned ‘big bang’ go-live will see 4,000 of the trust’s 12,000 staff use the system in the first instance.
The full implementation covers: patient administration, accident and emergency, results review and orders, medication orders, theatre (operating room) management, and pharmacy management systems.
Allison said the relationship with UPMC and Cerner has been positive. “We’ve had a lot of support from UPMC and Cerner. They know how important this is to their reputation in the UK.”
He added that Newcastle aimed to be an “exemplar” and this would necessarily take time. “This trust is a huge, complex organisation. We want to make sure this project is done right.”
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1 Substantial Stakes for Success or Failure03 Sep 09 03:49 Should the big bang implementation become a horlicks, patients will suffer, reputations will be depreciated, and interest of other trusts to purchase this system will fade. Cerner and UPMC are to be commended for learning from their R and D at beta sites in the US. The stakes are substantial whether there be success or failure for Newcastle. Is it true that Newcastle gets the system for free if it succeeds as an "exemplar", influencing the purchase of these systems by others? (post edited by EHI) 2 Business change and stuff03 Sep 09 09:03 Good on ya Newcastle. If they have data issues get them sorted first. And at last the NHS is starting to see that the implementation of these systems are a business change project first and an IT project second! I wonder if they have completed the training though if so the extra cost will be large. They say no real timescale, don't believe this, unless they have no project plan! 3 Situation normal then...03 Sep 09 09:32 “So another go-live cancelled at short notice. And here was me thinking that the Pittsburgh Medical Centre would storm up on their white chargers and show the NHS how to install Cerner safely and on time. IMHO there is clearly a lot more wrong with this project than just data migration. The trust don’t even know if it will be possible to go live this calendar year. Training users more than 8 weeks before go-live has been a major cause of the problems at other sites. This is particularly important with Cerner because it is not intuitive for English users. So will they bite the bullet and retrain (not refresher train) thousands of users?
Technical go-live is usually what happens when the system doesn’t work but the supplier wants paying. I wonder if money is changing hands here. Will this delay will cost a fortune? I wonder who is paying as CFH aren’t around to pick up the cost this time. Still at least they had the sense to cancel rather than plough on towards another potential Royal Free type nightmare.”
4 Who will tell Royal Berkshire?brian.hogan@live.co.uk 03 Sep 09 11:51 I wonder how this news will affect the outline plans of Royal Berkshire? They decided to spend millions of extra Trust pounds to choose a UPMC deployed Cerner instead of a National Programme version. If speedy implementation was one of the reasons for this independent spirit they must feel a little let down now. Does anyone know how many good folk from Pittsburgh are currently working in the UK? Perhaps we need some more. 5 Where is the Crowing ?03 Sep 09 13:49 Where are the usual suspects who pile in when a National Programme deployment is delayed ? Sounds very wooly what is coming out of the Trust, it could have been written by CfH! 6 re: Where is the Crowing ?03 Sep 09 14:25 There's no 'crowing' because if this had been a CfH project this particular delay probably would not have been permitted. They would have pushed ahead, crashed, burned and the patients and staff would have been left to pick up the pieces. 7 Project Management03 Sep 09 15:49 I come back to my point that no one has picked up on. What does the Project plan say????? 8 Correlation ?dlw@westburton.com 03 Sep 09 16:52 Is it just me, but there seems to be a strong correlation between go-live delays/failed implementations in NHS trusts and Cerner............ Doesnt seem to matter whether it is UPMC, Fujitsu, or BT. Should we not simply acknowledge that the NHS is a bit different to the US health system, and choose systems accordingly ? 9 re: Correlation ?04 Sep 09 07:30 Absolutely right - let's get rid of all US suppliers. They know nothing about our unique healthcare system. Those American hospitals don't record notes on their patients, they don't place orders electronically, they don't need results to come through to clinicians from labs and x-ray! I'm certain if they had an A&E department over there we would have heard about it (bet they would call it something stupid like an "ER"). It's obvious from the story above that they can't do data transformation properly... hang on! What do you mean that was done by Avoca. There not American! How can that be? Oh well let's blame UPMC and Cerner anyway that's much more fun. Damn those Yankee GIs with their candy and nylons. Coming over here stealing our women! 10 Will this implementation be a real EPR?maryhawking@tigers.demon.co.uk 04 Sep 09 08:39 I have been confused about the reality of hospital EPRs for a while, so could someone help? This is a big bang approach: does this mean that from go-live all patient medical records will be held electronically, and only electronically? As a GP, it took 6 years before we were confident that it was safe to operate as a paperless practice: what is being done about getting current medical records into the new electronic system, whether from paper or a previous system? Will there be real e-prescribing i.e. all prescriptions issued against individual patients, with batch numbers attached/recorded? (I hope so: it was a major shock to find this was not already the case - and the TTOs on the new EDLs (Elecronic Discharge Letters add to patient risk rather than reducing it!) What Coding system is being used? Is it the semi-mythical SNOMED-CT? and how will this relate to ICD-10 Coding? after all, PbR depends on ICD and OPCS Coding: I haven't heard that HRGs have been mapped from SNOMED-CT yet! Finally, good luck to Newcastle: thank goodness for at least one Trust prepared to get things right before going live! 11 re: Correlation ?04 Sep 09 11:07 There is a strong correlation between all large IT projects and schedule overruns. 12 go-live was in project plan04 Sep 09 14:30 The project plan says go-live 1st of September. Judging by their apparent understanding of their current state of readiness, I suppose they will set another date at some point, but it is unlikely to be much more than a marker. 13 Realism in Timescalesalex@alexgeddes.com 04 Sep 09 14:37 Anyone who has gone big bang (wide spread implementation in a hospital) with patient and clinic management and clinical orders and results has been unable to implement in less than 3 years of intensive and wide spread work across the hospital and care pathways. This was known at the time of the London LPfIT contract award. One candidate for the contract admitted this and factored the costs into the programme. They lost. The other chose to ignore this but did have a workable product set that has subsequently met the DSCN and other changes in the NHS directives. (This has been at local expense and not part of the National Programme). The then Director General for IT in the NHS then changed this option for the declined option. This is the tragedy that remains with us and is possibly passing to Australia. The timescales for adaptation of a US model of healthcare to the NHS remain the same whatever anyone says. Don't hold your breath for an American led solution this week without the necessary work to succeed by wide groups of committed stakeholders in the UK organisations where it is being implemented. 14 More time and planning needed04 Sep 09 17:31 Well done to Newcastle to have the guts to say STOP. All too often with many recent EPR projects its been a case of 'get it done now' rather than ' get it done right' If it was up to UPMC they would probably gone live as many of their staff are already at RBH with more arriving next week and I suspect that they just want to get this project over with. Newcastle have had the sense to realise that its about user and stakeholder buy in and not just about switching on some IT. 15 Learn from historytim.benson@abies.co.uk 06 Sep 09 21:39 One of my favourite quotes, relevant to this thread, is from Mel Hodge, who led the implementation of the World's first comprehensive HIS at El Camino Hospital, California about 35 years ago and subsequently led several other successful implementations.
Success has repeatedly been demonstrated to be the consequence of each doctor, one at a time, coming to see how his performance is enhanced by investing his always scarce time in learning how to use the system efficiently. Similarly hospital managers must participate in and buy into a carefully designed benefits realization program before they can be reasonably expected to act.[i] [i] Hodge MH. History of the TDS Medical Information System. In Blum BI and Duncan K (eds). A History of Medical Informatics. ACM Press 1990, page 342.
16 No investment in systems that work, please07 Sep 09 12:19
In reply to comment 8, In recognising that American Healthcare Systems don’t actually work in the NHS; Trusts would be forced to consider some of the many highly regarded existing systems that do actually work. God forbid… this would save considerable time, vast amounts of money and the ensuing stress for staff in an already overstretched service. It would also put investment back in the 17 Reply to Comment 1407 Sep 09 14:02 Surely Newcastle were involved in the original project plan and should have said at that point that the timescales were unrealistic - they after all are the customer and in America the customer is always right!! I suspect they were blinded by the shiny teeth - roll on the New Year and the next go-live date!!
18 reply to answer 1707 Sep 09 15:18 17 very very clever. When you say new year you don't actually say which new year! 19 Unrealistic timelines?08 Sep 09 10:51 From my experiences both on the NHS and the software supplier side - it is less often the software supplier who pushes for unrealistic timelines. I concede that is once the marketing bunnies are out of the picture - and also depends on how penalty clauses pan out - but it is always caveat emptor. Healthcare IT projects can be done well, but as a rule the harder, bigger and more ambitious they come - the harder they fall. Newcastle's pragmatism and lack of hubris or blame allocation at this stage bodes relatively well. Also they may have avoided the twin traps of "we're late but we'll deliver more" or rapidly committing to an inadequate breathing space only to announce further slippage six weeks down the line. I hope so! 20 Deployment model08 Sep 09 12:21 Like the majorty of posters here, I would add my support to this Trust in delaying the go-live until they are more confident in the impact that such a change will have on their organisation. I find it interesting (and somewhat depressing) that this particular solution continues to be so fraught with problems in its deployment phase. As others have mentioned, it seems that the problems encountered from previous sites have again become apparent. A basic grasp of project / programme management teaches that the worst mistake to make is to repeat a mistake made previously. And here I would tend to look to the supplier rather than the deployment model. The supplier is the single consistent organisation who has all the product knowledge and the experience of all the UK deployments. Each 'new' UK deployment would (generally) involve a large number of people (Trust / LSP / other delivery organisation) who require guidance and assistance from those with the greatest knowledge as relatively few would have had exposure to the solution previously. Has there been an example in the UK of this solution being deployed successfully into an acute provider by the supplier themselves ? With the possible exception of Newham (some years ago), I think the answer is 'no'. Would this route be any more successful at the moment ?
21 Fact or fiction08 Sep 09 21:34 I'd be keen to know the 'real' story within all of this, something that we will probably not know until post go-live. What are the real issues and why have Newcastle not gone live yet? Is it Avoca (as one comment suggests are involved), is it the final system or are Newcastle unrealistic with their expectations of the product? How are Newcastle planning to cope with the operational changes of such a large implementation? There is a never a good time to go-live with such a large system change from an operational point of view, but you have to bite the bullet at the right time. What is different from the London NPfIT implementations that means that Newcastle will not face the same problems? I would imagine that a lot of eyes are on Newcastle to ensure that their non-NPfIT implementation is a success. Good on them for not doing it until they feel that they are ready, but watch this space... 22 So the project is delayed - so what?sue.wilson@swbh.nhs.uk 08 Sep 09 22:15 Gosh doesn't everyone come out of the woodwork when a delay in a Cerner implementation is mentioned. Sorry, but it provides me with some laughter. What do many of you really know about Cerner? Certainly, by your comments very little indeed. Have you any idea how many countries Millennium is deployed in? The US do not electronically request tests or investigations, I read, well obviously you haven't been to the States. The NHS healthcare system is unique - rhubarb! It has its isolated uniqueness, but not in totality for sure. Do you think the Canadian healthcare system is so unlike ours? Nope, and yet they can implement Millennium. The fact is it is implemented in a number of countries worldwide and is actually most successful. How do I know? Because I have implemented it myself before I rejoined the NHS some years ago. Newcastle are correct to extend a project and give more time to data migration if they wish, pure sense. I commend them for that. Can they do a big bang with a PAS and electronic ordering - of course it is possible and no it does not have to take 3 years. Not if you have the buy-in from your Trust and the staff are on the ground to support all the end users. Don't believe me, then ask Dewsbury NHS Trust. They deployed in the days of HISS a similar deployment approach and again with an American supplier. It was tough, but they did it. So I can't get too excited about delays. If they achieve a big bang deployment in even 12-18 months, that will be amazing. Good luck and I admire them for the challenge they have set themselves. As for the constant knocking of Cerner, well when you think that also Wirral, with their long history of success with EPRS, chose them too, then they sure can't be all that bad. Personally, it is about time, whether a local or a NPfIT approach, that we in NHS IM&T, just actually spent less time talking and maybe just got on with it. Then what would I know?! 23 Re: comment 22davespod@yahoo.co.uk 09 Sep 09 10:49 Regarding the comments relating to comment 7 - no electronic ordering, etc. I know sarcasm doesn't always come across well in a text-only medium, but I would have thought the author made the sarcasm pretty plain once he started claiming the absence of any equivilent of A&E in the USA. I think he may have been making the same point you were! 24 Comment 2209 Sep 09 11:49 Evangelists are useful in some circumstances and high risk in others. It is true from what I hear that Cerner can put a patient through a pathway in many other health "systems". What is unproven is whether Cerner can run the business side of an NHS hospital at the same time and by this I mean all the quirkiness that has built up over the years. This is idiosynchratic in the extreme with unique data items collected at unique points in a pathway that are clinically insignificant. On the other side it is doubtful whether you would ever achieve full business continuity in a go live of such magnitude in an organization as complex as a large acute Trust. Unfortunately we don't even know if the pre-Cerner systems were operating with accuracy - in fact we can safely assume that they were not. It is the baseline change however that makes things difficult and that will be a management headache regardless of how well adapted the system is. The latter remains a large risk due to the fact that this system has never and will never be built around the NHS data model. That is why Newcastle is so interesting to the rest of us, cynics and evangelists alike, and just like in politics no doubt both sides will claim victories! 25 Crowing about comment 610 Sep 09 10:21 So when NPfIT delay it's because they can't manage projects, yet the trust are brave when they delay. The biggest criticism levelled at NPfiT are around the delays to projects and non-delivery of products, not issues with products deployed http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/153.pdf |
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