iSoft to go direct to South with Lorenzo

Tags: A Alert ASCC Bury Choice Cohen CSC DH England Government iS iSoft Lorenzo NPfIT UK US

08 Oct 2009

ISoft has confirmed that it will start selling Lorenzo directly to NHS trusts in the South of England, in a move that appears to put it at odds with its biggest customer, CSC.

The health software firm will offer trusts what it describes as fully-NPfIT accredited version of Lorenzo. The aim will be to work with customers’ existing systems, using integration technology to gradually migrate them to Lorenzo, avoiding ‘big bang’ implementations.

The company says the decision follows recent changes to the National Programme for IT in the NHS in the South of England and the opening up of the market.

CSC is the LSP responsible for delivering iSoft’s existing software products and future Lorenzo system in the North, Midlands and East of England. However, iSoft now says that in parallel to its LSP contractual commitments, it will go direct to market in the South.

A long series of delays in providing the Lorenzo software for NHS use has placed both firms under intense pressure. Both are now working to hard deadlines set by the Department of Health. The first, at Bury, falls in November.

By going direct, iSoft appears to be jumping the gun on the DH’s promise to set out plans to deliver some choice of systems in the South. These were due to follow the November deadline set by the DH for iSoft and Cerner to show they can deliver ‘strategic’ systems to the NHS.

In April 2008, the DH removed Fujitsu as LSP in the South and then decided not to appoint a replacement.

Twelve months later BT, the LSP for London, was awarded a £546m contract to support the eight trusts already running Cerner Millennium and to install it at four more acute trusts, while delivering 25 implementations of RiO in mental health and community services.

However, the deal left 29 acute trusts without an LSP-provided solution, and a promise of limited choice. EHI has been told that the DH wants the three southern strategic health authorities to orchestrate trusts’ decisions.

The mechanism to deliver choice in the south is almost certain to be the Additional Supply Capability and Capacity (ASCC) framework. This places CSC in a bind, as its ASCC software partner is thought to be Alert Life Sciences rather than iSoft.

ISoft claims half the hospital trusts in the South currently run one or more iSoft software product, and many may prefer a direct relationship.

Gary Cohen, iSoft’s executive chairman and chief executive officer, said: “The changes to the programme allow us to build on relationships in the south that existed before the programme began.

“We are now re-engaging with these customers to upgrade existing systems, and contribute to a strategy to gradually replace these systems with Lorenzo.”

Adrian Stevens, ISoft’s UK managing director, added: “ISoft continues to actively support both CSC and NHS Connecting for Health in achieving the goals of the NPfIT and core IT strategy by continuing to deliver Lorenzo to the contracted regions in England.

“But, in the absence of a LSP in the South, we are now giving trusts the option of contracting directly with iSoft for the NPfIT-accredited Lorenzo.”

In a briefing to investors last week, Cohen said NPfIT “may evolve into an open market.” He also said that if the Conservatives come into power next year, and allowed trusts to choose their IT suppliers as they have proposed, iSoft should benefit substantially.

“The potential change in landscape to the national programme by the Tories, should they form government in 2010, is a potential boon for us. We are well positioned to benefit from a direct engagement model with our customers and we have a substantial presence with existing solutions right across the NHS.”

Cohen was bullish about being able to see off competition from other companies in an open market in the South, such Cerner, UPMC, System C Healthcare, Agfa Healthcare and Siemens.

“We have a large existing product portfolio at work in the UK market today, unlike any other potential competitors.”

Jon Hoeksma

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Readers Comments

Lorenzo down South!!!

08 Oct 09 12:28

Wow Lorenzo in the South, they might even beat the North to an installation you never know.

So its having problems upt North – lets spread them ever further afield.

BIG BANG

08 Oct 09 14:31

After many years of keeping track on E-Health insider, and the comments, this is my first real posting. I am not addressing the main thrust of the article but one aspect of it.

The big-bang is too risky and should be avoided. Forget the thousands of staff at Trusts having been trained (some many weeks ago) all trying to hit the ground running at the same time. Even if it did work which, to date, hasn’t, is still too risky and roll back would seem to be impossible. Get the old system, talking to the new system and gradually roll it out. The interfacing of the two systems will be technically challenging but should be within the wit of man. Only when users in one area are happy that it is fit for purpose do you roll it out gradually. I emphasise “users” and “fit for purpose” because they are the only ones that know and, no matter how much requirements gathering and documentation (which seems to be a major part of LSP/SHA/CfH life) happens, things on the ground are different. Finally, it would seem that, after many years of getting this wrong, someone has read or listened to the lessons learned and accepts the “big bang” does not work.

We (the NHS) need to accept that our processes, procedures and our culture may need to change and we must embrace this but never to the detriment of patient care.

All that being said, the product has to hit the ground running; it must be stable, fulfil requirements and be configurable to differing environments. The providers must accept that delivering to abstract requirements is different from delivering a fit-for-purpose application (working as designed is not the same as fit for purpose). From what I have seen, this product is not there yet. We must accept that third parties have timescales, deadlines and profit margins to meet that means this work can not be open-ended.

Much of the above was created prior to this article – just did not have the bottle to make my thoughts known.

The final straw?

08 Oct 09 17:07

Could this be the final straw which ends the stormy relationship between CSC and iSOFT?

With Lorenzo's understudy (TPP Acute Care) waiting in the wings we may see a new actor on the stage next year.

The old cast didn't really deliver did they...

Re: the final straw?

maryhawking@tigers.demon.co.uk

09 Oct 09 06:56

If iSoft, from a secondary care background, has been unable to make a secondary care EPR (where this means holding patient medical records electronically with the supporting infrastructure of patient registers, prescribing/dispensing/administering medication, etc rather than a PAS) why do you you think *any* primary care system provider is likely to be successful?

Uninformed scepticism?

09 Oct 09 17:03

Mary Hawking can be expected to be sceptical about the ability of primary care software suppliers. As a prominent member of the Emis National User Group she has obviously had first hand expereince of Emis and their attempts to write a patient-centric medical system.

However, I suggest that she simply calls TPP and asks for a demo of their secondary care system. This is exactly what we did and what we saw blew our socks off. We're taking it, as are a number of hospitals round the country.

Uninformed?

angus.goudie@GP-A89021.nhs.uk

10 Oct 09 08:47

I would supsect the answer is not uninformed, knowing Mary.

I know it is perfectly normal practice to remain anonymous on such lists, but it can be a screen for sniping. I take it you are in what, an acute trust? or mental health? I think it is is most important to do any homework on the areas of systems that have not been traditionally part of secondary care, and to take especial notice these days with data being shared between systems, of such issues as coding and data quality and the data architecture.

I would be interested to know TPPs approach to it's acute system coding, whether it is ICD10/OPCS based or using CT3, or has as the native consultation recording (not just the payment/business categories) SNOMEDCT. Lorenzo from what I saw of it in the early days was looking at fairly solidly embeded SNOMED, though OPCS/ICD remain important for business pruposes for now, but CERNER seemed to have it as a module for optional use, which would be less helpful in the longer term interoperalbility required between acute/ community/ primary care in a market that will inevitably remain plural in nature.

hospital taking TPP

maryhawking@tigers.demon.co.uk

10 Oct 09 10:05

Last comment is very intersting.

If a hospital trust is actually installing TPP acute, I'm surprised this is not widely known - surely there can be no grounds for secrecy?

Could the last poster tell EHI readers *which* acute trust is installing TPP Acute, and whether it is a totally integrated hospital system along the model of Millenium and Lorenzo, or a bolt on?

My views are my own, and the work on SSEPRs is looking at the theoretical model. Try reading the RCGP report, and see whether there are answers to the problems: everyone would be glad to know.

CSC and Alert Life Sciences

10 Oct 09 12:02

"...This places CSC in a bind, as its ASCC software partner is thought to be Alert Life Sciences rather than iSoft..."

Since Alert Life Sciences is on the ASCC Framework as a Supplier in its own right (for most CfH EPR Categories), why would anybody considering their offerings choose to procure through CSC? CSC wouldn't be an LSP in this scenario, so it's difficult to see what the benefit would be.

But presumably, CSC would be "an LSP" (albeit an out-of-area one) in offering Lorenzo?

I'm more interested in how Trusts using ASCC are to be funded; word on the street suggested that, in the South, CfH would pick up the tab in the same way as it would if the South still had an LSP, but I haven't heard of this happening - or even being about to happen.

Spine integration of non-LSP ASCC systems?

12 Oct 09 10:46

How is the 'spine' integration of non-LSP mediated secondary care systems deployments managed e.g. Personal Demographics Service, Choose and Book, summary care record etc?

Are these services negotiated directly between the Trust and the NASP (National Service Provider)?

Who pays the bills and is this yet another nice little earner for the contract lawyers courtesy of NPfIT?

Answers to the problems with the RCGP report

13 Oct 09 07:35

Mary

We need to know more about these unanswered problems please. What are they and who is working on the solutions?

To clarify; are you saying that there are unanswered problems regarding shared care? Are these problems unique to the TPP solution? Do other shared care systems have these problems? Do you know if EMIS Web has encountered these problems and if so what are the solutions?

SSEPR problems - ref comment 10

maryhawking@tigers.demon.co.uk

16 Oct 09 16:45

The problems in SSEPRs are generic: they have only been seen in TPP because TPP is the only live system using the model of "one record per patient": unless the team designing Lorenzo Regional Care has taken them into account, I would expect the situation on the ground to get much worse in the future!

This isn't really a problem with shared care - and EMIS Web, not being a single record, doesn't have the same problems.

Look at the theoretical model:

If you have a single record used by different organisations as the record of prime entry , how do you manage read, write and access permissions, who "owns" the total record, how do you manage changes in entries (medication is particularly important here: starting a medication in one setting may impinge on management of a different condition for which the prescriber is not responsible, or demand change or stopping another medication but this also affects disputed, mistaken and evolving diagnoses), how are the legitimate record requirements of different organisations to be managed (they may be incompatible!), who is the Data Controller in the legal sense sense when each organisation only "owns" a part of the total record, yet depends on information entered in a different organisation.

I'm not saying that it is impossible to manage SSEPRs - and if they were on paper it would be a different problem! - but I have not seen any solution, and I have not managed to construct a theoretical model.

With the difficulties, isn't the sharing of relevant parts of individual records, or even complete records presented as a logical whole an easier approach?