Lorenzo has just 174 'regular users'

Tags: A Bradford Bury Government iS iSoft Lorenzo Mike Mike O'Brien Morecambe Bay NPfIT

02 Nov 2009

Figures released by the government show that a year after the first trust went live with Lorenzo there are only about 174 “regular users” across the five NHS trusts using the system.

The figures, given last week by health minister Mike O’Brien in response to a question from Conservative MP Richard Bacon, relate to the use of Release 1 of the care records software.

They show that the software remains at a very early stage of deployment; so far it is only being used in strictly limited areas of a small number of hospitals.

University Hospitals of Morecambe Bay NHS Trust, the flagship acute site, has only 96 users a year after it first began to roll-out the system. By June, just three wards at the relatively small Furness General hospital had gone live.

South Birmingham Primary Care Trust, which has been using the system for more than a year, only has 16 regular users. At Hereford Hospitals NHS Trust, there are just seven regular users.

And at Bradford Teaching Hospitals NHS Foundation Trust, which began to pilot the system in a joint replacement clinic in April, there are just 12.

Five Boroughs Partnership NHS Trust, the first mental healthcare trust to begin using R1 so far counts just 43 users.

O’Brien also revealed that the highest ever recorded number of consecutive users of Lorenzo was 19; a figure reached on 6 October.

CSC holds local service provider deals with the Department of Health totalling almost £3 billion, which centre on delivering Lorenzo to almost 60% of the English NHS.

To come close to success, the system will have to be used by tens and then hundreds of thousands of users. Payment on the LSP contracts was originally said to be based on delivery and usage of systems.

The figures are far lower than those previously indicated by CSC and the individual trusts. Five Boroughs told EHI in October that it had 150 clinical and administrative users.

Explaining the low number of consecutive users, the health minister said: “The number of concurrent users of the system is lower than the aggregate number of regular users because clinicians spend the majority of their time working directly with patients.”

He added: “Time spent using the system is relatively short, and in most care settings, users will log in and log out of the system repeatedly throughout the day.”

So far, CSC and iSoft have only provided NHS trusts with R1 of the Lorenzo software, which provides limited clinical tools, on top of an existing patient administration system.

The much fuller Release 1.9, which for the first time includes a PAS, is due to go live at NHS Bury, followed by Morecambe Bay.

Assuming the successful delivery and roll-out of R1.9, usage numbers should significantly accelerate. The plan is for NHS Bury to become the first NHS organisation switch to the Lorenzo with a PAS, which will involve up to 600 new users out of 800 staff.

If Bury is a success, Morecambe Bay is then set to become the first big acute trust to switch off its existing PAS and move to the new system. This would entail thousands of staff starting to use Lorenzo.

Jon Hoeksma

Bury misses early planning go-live (29 Oct 2009) (9)
Five Boroughs goes live with Lorenzo R1 (09 Oct 2009) (7)
Bradford plans Lorenzo expansion (28 Aug 2009)
Morecambe Bay completes Furness pilot (24 Jun 2009) (5)
Bradford goes live with Lorenzo (09 Apr 2009) (12)
Soft launch of Lorenzo at Morecambe Bay (06 Nov 2008) (27)

Readers Comments

What's the situation with Cerner sites?

02 Nov 09 14:30

This is truly shocking, unless I misunderstand the planned pace of usage uptake. Is this what the Programme has been anticipating throughout & in recent publicity messages about Lorenzo implementations?

Equally importantly, is this the standard level of take-up across the National Programme & does this apply to the Cerner sites that are live in London & the South. What are the user numbers there & what is anticipated where Trusts, such as Newcastle, have gone outside the Programme?

Yes Minister ... just shy of 175

02 Nov 09 17:30

note to Sir Humphrey - thks, that'll show em!

Depression..?

02 Nov 09 17:31

I had expected a flood of responses to this news..I expected people are just too depressed to bother.

In answer to 1, I know that the Paris Mental Health Implementation in Tees Esk and Wear Valleys got 4000 user live over a 6 month implementation period!!! Perhaps this reflects the fact that MH services are primarily community-based and not ward-based as Lorenzo seems to assume...

the silver lining?

cunpr@globalnet.co.uk

02 Nov 09 21:48

Well at least we can now work out the "cost per user" of the program. Didn't Grainger complain about the absurd lifetime costs of systems purchased before he modernised (sic) NHS IT procurement? Well now we can work out how much the program has cost per user. Gulp.

Regards

Paul C

It all comes out in the wash

03 Nov 09 09:28

Maybe now the powers will be will accept that the claims of having "gone live" were a complete exggeration and that having a tiny piece of a proposed system that works and is being used, has only served the point of costing the NHS a fortune for a minimum number of deliverables.

I for one am hoping that the "go live" at Bury slips even more so that hopefully this excuse for a contract will be torn up and we can have a look at a system that both works and is written with a decent architecture (I hear that 3Gb is the amount of RAM needed to attempt to run 1.9 at anywhere close to sometheing that resembes basic).

Say no more, say no more

03 Nov 09 09:39

I think the lack of flurry of comments is down to the the article speaking for itself. What a shameful and sorry situation.

The numbers game

03 Nov 09 11:44

As many as 174?

Of course, the acid test will be the number of users when the initial wave of enthusiasm has waned!

Nursery rhyme time

03 Nov 09 14:19

When I think of NPfIT the old children’s song "The King's New Clothes" comes to find, it will be for others to decide who are the two swindlers, but it is easy to identify the King and the magic suit being Cerner / Lorenzo / IDX. Billions have been spent and 6 years down the line we seem to be little further forward. PACS has been a great success, but the only company that actually managed to deliver to any scale has left the programme - namely Fujitsu, they led the way on PACS and RIS, and CSC were told to follow, they also led the way for BT to drop IDX and take on Cerner - Fujitsu delivered eight sites but they realised as did Accenture that delivering one major system across such a huge and diverse infrastructure was hard to say the very least. Also as a matter of interest for those systems that have been delivered by BT and CSC who has actually done the work - System C, Perot.......???

For the amount we have spent on NPfIT we could have delivered an integrated care record where the clinician could have a view of all the relevant patient notes. We could have implemented systems that enable hospitals to free up trapped data in legacy systems and use this as the basis for a scalable incremental electronic patient records. This approach would give significant clinical benefits and reduce the risk of implementing huge EPR systems - it can be modular and flexible, and delivered at a fraction of the cost of NPfIT and in a fraction of the time.

This approach would have given reduced costs within a hospital / clinical setting, improved clinical efficiency through access to better information, speed up the administrative process, provide better care through better access to information and overall improve the patient experience. At the end of the day the original goal was for an integrated EPR.

Concurrency

nhstechie@btinternet.com

05 Nov 09 22:35

Concurrency rates can be misleading in the NHS - especially outside ward based services.

I can't comment on the other Trusts' figures, but 5 Borough's 43 (>28%) concurrent user figure is as expected and is typical of a community service - irrespective of the system being used.

This project was scoped for a user base of around 150 community based CAMHS staff (mainly clinicians as this was principally a clinical documents project) who aren't often at their desks at the same time.

Our PAS replacement project in 2010 will have a user base of around 1,700. I expect concurrency rates to be higher as this second project will include in-patient services and will have a higher proportion of administrative staff.

Dave Kelsall
Assistant Director - Informatics
5 Boroughs Partnership NHS Trust

Thanks for clarification

jon@e-health-media.com

06 Nov 09 09:56

Dear Dave

Many thanks for the clarification on concurence rates at Five Boroughs, now and for the future when you install the PAS.

A really helpful and useful post and clarification. Best of luck for the future.

Jon Hoeksam, editor E-Health Insider.

Apples and oranges

06 Nov 09 12:32

The headline and start of the article talk about "regular" users while the comments seem to be about "concurrent" users. Which is it? 174 concurrent users MIGHT be acceptable if there are a large number of people who use the system (regularly) for short periods.

Who are the users

11 Nov 09 08:04

As these systems (Lorenzo and Cerner) are supposed to be clinical systems it would be interesting to know how many users are clinicians recording patient care. From what has been seen in Lorenzo and Cerner there is very little clinical content. Is this just administrative use?

What data is stored

11 Nov 09 11:15

Another interesting fact would be some analysis of the type of data stored. It is possible that not only are there a small number of users but that the amount of data being held is of little value as well.

In terms of usage does the system allow administrators to log on as though they are clinicians? What is the proportion of usage by admin and clinical staff? My past experience of Psychiatrists writing up CPA notes is that they tend to pass it to the nearest nurse and tell them to fill it out. Is this the reflected practise in Lorenzo?

Until practitioners of any persuasion feel they have a system they value because it is a key part of their work any system will always suffer from lack of usage. The key is to link the data to wider inspection and audit so that a lack of data is publicly validated by others who do look at it.