Bury goes live with first Lorenzo PAS

Tags: A Christine Connelly Connelly Information iPM iS iSoft Lorenzo Morecambe Bay NHS Bury PAS US

03 Nov 2009

E-Health Insider has learned that NHS Bury has gone-live with Lorenzo Release 1.9, the first version of the software to include native patient administration functionality.

The trust went live with the new system, after switching off its old PAS, this morning.

NHS Bury is the first trust to go-live with Lorenzo Release 1.9. Until now, CSC and iSoft have only provided NHS trusts with Release 1 of the Lorenzo software, which provides limited clinical tools, and runs on top of an existing PAS. Release 1.9 for the first time includes a native Lorenzo PAS.

At the beginning of October, the trust outlined the scope of Lorenzo claiming that it will “implement Lorenzo Regional Care Release 1.9 in November, when it will migrate off its current patient administration system.”

A statement issued by NHS National Programme for IT in Greater Manchester, said: “NHS Bury is pleased to announce that, on Tuesday 3rd November, Lorenzo Regional Care Release 1.9 (Care Management) was successfully deployed in the Trust.

“Almost 600 clinical and administrative staff across 31 community services are now using the system to manage their administrative tasks including booking appointments, recording contacts and managing casenotes.

“The migration from the trust’s previous patient administration system, iPM, took place over the weekend following extensive testing by the Trust, NHS North West, NHS Connecting for Health and local service provider CSC.”

In April, director general of informatics Christine Connelly set deadlines for local service providers, CSC and BT, to achieve “significant” progress with the ‘strategic’ systems they are due to deliver.

She said that CSC must get iSoft’s Lorenzo into a care setting by November and “working smoothly” in an acute setting by March.

A successful go live of Lorenzo 1.9 at Bury is widely seen as an essential step before a subsequent go-live at University Hospitals of Morecombe Bay by the end of March.

According to the trust, the project team is now preparing for the phased roll out of Lorenzo electronic clinical documentation functionality to services that is due to start early next year.

Ann Halpin, associate director of IM&T, at Bury said: “Following months of preparation, we are delighted that Lorenzo Regional Care is now in place. During the deployment, our priority has always been to ensure that the system supports our staff in providing high quality care for our patients.

“We are confident that Lorenzo Regional Care is the best solution to enable us to share information swiftly and securely between services and, in time, with other organisations. As more Trusts deploy the system we will start to realise the full benefits that the NHS Care Records Service will bring for our staff and patients.”

Sarah Bruce

Lorenzo has just 174 'regular users' (02 Nov 2009) (13)
Bury misses early planning go-live (29 Oct 2009) (9)
Bury outlines scope of Lorenzo R1.9 (06 Oct 2009) (7)
Connelly sets a November deadline for suppliers (28 Apr 2009) (12)

Readers Comments

honesty please

03 Nov 09 14:38

How about we have some quotes from end users and not directors ?!

Quotes from users?

03 Nov 09 16:59

They could not ask the users they were both busy!

Re: Give it a rest

03 Nov 09 20:11

Cynical - yes! It's only a bl**dy PAS system - what on earth is there to crow about?

Well shock horror

03 Nov 09 21:43

I'd bloomin well expect it to go well. 5 years later with the might of a global development team they've delivered....... a PAS.

Users are managing to throw data into a system. Woopeeee.

Please come back later and tell us

a) that they have over a couple of thousand concurrent users

b)they can actually tell their customers what they've done and within 18W targets etc.

c)that they are moving patients around the system effortlessly

d)they have removed x% admin staff in their organisations

Then it will be interesting. If they haven't done those things then why bother. Smart money still on cynics for now?

Cynical, moi?

04 Nov 09 12:35

Your grandmother never says "I went to my Primary Care Trust today to have my rheumatics looked at".

While Primary Care Trusts do directly employ clinical staff, a PCT is a QUANGO, not a tangible healthcare facility i.e. hospital or GP surgery.

A large part of a PCT's business is administrative. Patient registers aside, these administrative functions do not closely resemble those of a secondary care trust or hospital. In particular the mandatory activity reporting requirements of secondary care (the only thing which worries directors and have caused so much stress in BT/Cerner land) are wholly distinct.

It's also unlikely this PCT system will have interfaces to LIMS, RIS etc. Certainly interfaces with A&E, maternity and operating theatre systems are off-piste.

Does this Lorenzo PCT system even yet interface with the Spine (PDS etc)? Is there communication between this system and the PCT's GP practice systems?

Overall this go-live (even taken at face value) can answer hardly any of the serious questions about Lorenzo's readiness for secondary care or indeed as a replacement front-line GP system, both of which it has been marketed as from the outset.

Cynical? No - heartbroken! This has been a lost decade. Rich clinical secondary care systems have been available since the 1990s - hospitals still lack clinical tools which GPs have taken for granted for twenty years.

Never mind - Lorenzo 1.9 has been delivered, Christine Connelly's box can be ticked and all incumbents are now safe until after the General Election.

Sadly even after that is there light at the end of the tunnel? Even if the Tories have a superior plan (and the omens so far are dismal) it's unlikely they can undo the LSP contracts without facing penalities rivalling bank bail outs.

NPfIT may be amongst the largest and most expensive domestic political mistakes of the Century so far. And the public know nothing of it.

Two things

04 Nov 09 17:15

1) Has this system really just gone live this morning? Or has it passed it's acceptance testing. Seems awfully premature to be announcing a golive on day one.

2) While the commissioning part of a PCT is mainly administrative, PCTs do provide community services, such as District Nursing, Podiatry etc. although their Information collection is fairly basic at the moment.

Dear oh dear...

04 Nov 09 22:15

"just a PAS"... perhaps you should educate yourself a little before making idiotic statements like that. The whole point of Lorenzo is that it's not "just a PAS". Have you ever seen Lorenzo? Ever used it? Thought not.

Dear oh dear oh dear...

05 Nov 09 17:13

I’m trying hard, but I really am puzzled.

Poster 8 suggests that “…it’s not just a PAS…”, and decries Posters 4 and 5 for suggesting that, but the article seems clearly to suggest that this has simply been a migration from the PCT’s previous (iPM) system which was, err.., a PAS and that “…Almost 600 clinical and administrative staff across 31 community services are now using the system to manage their administrative tasks including booking appointments, recording contacts and managing casenotes…”, which I’m fairly sure are, err.. PAS functions.

He/she goes on to say “…Have you ever seen Lorenzo? Ever used it?...” .

I’m beginning to wonder whether he/she knows what a PAS or any other healthcare IT system is, Lorenzo or otherwise.

Care Pathway...

05 Nov 09 19:09

Ever heard of it? It's what iPM doesn't provide, and Lorenzo will. However the idiots who generally post on EHI stories are the usual miserable naysayers who can't stand it when progress is actually made.

Back to your green screen old timer, let progress make progress.

Editors note - Usually we wouldn't let such a bad natured comment through, but its a Friday morning and in the spirit of broad shoulders have made an exception. I would point out that readers who denigrate other EHI posters - in my experience a diverse, varied and extremely well informed group of people, who share the aim of seeing IT used to deliver better healthcare - tend to be the most narrow minded of our readers, with their minds closed to arguement and debate.

We know ...

05 Nov 09 21:41

We know you're upset ... but never mind, things won't look quite so bad in the morning, will it?

We know it's arrived very late ... but we're all upset about that, aren't we?

We know it was expensive ... but that nice Mr Brown has just given another £13,000,000,000 to the banks this week so maybe in comparison to that this isn't quite so bad as you thought?

We know this is just a PAS replacement ... but didn't everyone on here say we needed an incremental approach and avoid a Big Bang replacement of PAS, clinical and departmental systems?

We know it isn't an Acute hospital ... but no-one said it was and most healthcare is delivered outside hospital settings and isn't it nice that those of us who don't work in hospitals have nice new systems?

We know not many people are playing with it just now ... but wouldn't you have been upset if that nice Ms Connelly had given it to lots of people to play with and it didn't work properly?

We know you wanted to buy your own systems ... but wouldn't you have just bought the same things as you've done in the last twenty years and spent all your money on the Acute hospitals like you did under IfH?

This patronising, self-righteous, anonymous, posting was brought to you by someone who is sick and tired of all the patronising, self-righteous, anonymous, postings he's read on EHI in the past few years from both the pro and anti NPfIT lobbies. Can we please have a rational, adult and objective discussion?

Anon (why should I put my name to this patronising, self-righteous, anonymous, posting when hardly anyone else does?)

:-P

Flabbergasted by Negativity

05 Nov 09 22:31

A real shame to read such condescending and undermining comments. I wonder if the negative commentators have actually ever deployed a PAS System... The preparation for such a deployment cannot be underestimated, from the technical infrastructure, data migration, integration, business engagement, process change, testing and training to name just a few key elements. Oh yes and of course dealing with the inevitable issues around data management and data quality ahead of deployment (not afterwards!). So 'its just a mere PAS' well these systems happen to be the cornerstone applications in NHS organisations supplying a wealth of data that are valuable to support many important business functions, and yes also generally to support vital income. Yes, its taken a while to get Lorenzo up and running however I have an inkling that we will not hear the same kind of horror stories around this deployment as we have about the other NPfIT solution (or should I say Jumbo) that descended and caused mayhem in a number of Trusts during and after go-live Always better to prepare well and get it right both at organisation and solution level. Leads to a successful deployment and more benefits in the long run...

Good Luck to Bury I hope it goes really well.

What Lorenzo is

06 Nov 09 08:44

Just to make it clear please note the following.

Lorenzo Release 1

In-bound real-time PAS messaging (MPI and ADT etc);

Electronic Requests and Results for Path and Rad

Electronic Service Orders for other services

Structured recording of patient health issues (specifically allergies*, ADRs*, patient alerts, health problems* (symptoms and diagnoses), interventions* - for items marked with * you can add SNOMED CT terms to the record)

Clinical noting tool to create a semi-structured text-based record of care activities - tool includes templating, canned phrases and statements etc for rapid document production, tool can automatically cite content from the wider EPR record into the note and invoke other other Lorenzo functionality - Tool can be used to create clinical correspondennce which can also be transmitted automatically to recipients by secure NHS email

Clinical Data Capture Tool to create fully-structured record of care activities - forms use a consistent records architecture standardised across the Lorenzo user base to ensure consistency of meaning

A data extract facility to enable recorded Lorenzo data to be imported into external data warehouses for secondary analysis

Lorenzo Release 1.9

All of the above but in-bound PAS messaging is replaced with an integral PAS capability within Lorenzo itself - PAS does not include A&E capability

Lorenzo Release 2.0

All of the above plus A&E capability. TTO e-prescribing, day care and care planning

Even at Release 1 there is enough working functionality within Lorenzo to keep the average acute trust busy for *years* enabling clinicians to make the transition from paper to a structured electronic patient record - the early adopters have begun this journey but it cannot be done quickly (IMHO). For example 1 care pathway in 1 speciality in an acute trust can utilise over 100 pages of paper forms - it takes time to re-engineer this around an electronic system. Trusts who have already deployed enterprise order comms will know that this is not a quick or easy journey either.

At release 1.9 and 2.0 the potential is even greater. As more Lorenzo sites go-live there is the potential for data sharing between organisations. Currently not useful because of the geeographical spread of the early adopters.

Bury PCT has deployed 1.9 and is using the PAS capability now but will also, as the report suggests, start to use the clinical functionality within Lorenzo.

Lorenzo is not a PAS - it is an EPR system with an integral PAS capability - a 'super-PAS' if you will. It would be crying shame if this product does not survive the current politic. Lorenzo has the potential to transform the way that the NHS provides care and it needs to be given a chance to prove this.

Things can never get better.. for some..

06 Nov 09 09:38

First, there was the issue of Lorenzo being ethereal and there was ranting about how it would never see the light of day. It did in November last year. Then, it was about how the PAS would never come through or be fit for purpose. It finally has, with a realistic plan for fast followers.

Now its about how it's 'just' a PAS. There may be other systems that can perform 'miracles' as highlighted so often, but the key difference with Lorenzo is and will be its ability to evolve and scale, faster and cheaper than any existing legacy PAS. In addition, there is a cleaner interface, better integration of clinicals and PAS, workflow management, the benefits of which can only be realised on the longer term.

Yes, things could have been done sooner, the processes could be improved enormously, there could be better co-ordination among stakeholders, the list will go on for cynics who can never see the fact that some have continued to perseve on to make this a reality and that with a little support, might just be enough to realise the vision..

Sad....

06 Nov 09 12:59

Congratulations if progress has really been made. However one has to infer from all the comments above that there is a huge disparity between expectations and reality.

This development has been so disastrously slow and costly that both sides appear to have been reduced to throwing petty insults or trying to justify what is truly pathetically little.

We need to remember that whilst these little progressions are welcome in reality there are tens of thosands of healthcare professionals that are currently stagnated awaiting real progress.

Sounds like sales talk

06 Nov 09 14:50

Notwithstanding the foregoing spat, I'm maintaining my position firmly in the cynic's / realist's camp (where I've been waiting since 2003 for a transformational conversion experience based on hearing the merest hint that something useful that matches CfH's promises has been delivered).

So today I read in post 13 (surely a portent?):

A key feature will be "its ability to evolve and scale, faster and cheaper".

But isn't this sort of thing exactly what we've been hearing about NPfiT's deliverables since the early days of the Granger era? Where is the evidence to support this? Show us please.

Ho hum...

andrew.fearn@nuh.nhs.uk

06 Nov 09 16:12

There are times when people who are saying it can't be done - (those anonymous posters on this site for example) - are interrupted by those who've just done it...

Well done Bury PCT and all of those hard working staff who've proved the whingers and whiners wrong! Bring on Morecambe Bay...

"Ho hum" in context please

07 Nov 09 07:40

Perhaps Andrew Fearn could explain for us detractors exactly what it is that has been achieved at Bury by putting it into the context of:

1. How the functionality available to users in Bury here and now compares with NHS IT systems in use 10 years ago?

2. Viewed from an NHS-wide perspective and just looking at the functionality now available at Bury, what percentage of the NHS still needs to have this level of functionality delivered?

3. How can we extrapolate from this implementation that it will evolve and scale quickly and cheaply?

It's the answers to these sorts of questions that will help convince people like me that the programme really is moving forwards successfully.

Moving forwards!

09 Nov 09 11:22

Yes, of course things are moving forwards. The first of type for Lorenzo 1.9 is now live!

Great - though perhaps it would put things in context if we noted that this should have happened 12 months ago.

There have been a number of PCT's who's 12month+ planning has revolved around being fast-follwers due to implement in October this year and who committed large amounts of staff and other resources - to the extreeme detriment of other worthwhile health and social care projects - utterly wasted.

Lorenzo may be a platform technically capable of being more flexible in the future but I for one (and I have first hand experience) would say that any system that has an 18 month design cycle followed by an 18 month build cycle followed by at least 12 to 24 months of deployment CANNOT meet the needs of a rapidly changing health service.

The design for version 3 of Lorenzo was closed last autumn and contains all sorts of nice headline features such as Single Assessment - but most of the design was already 18 months old then and so often was already badly out of step with current practice.

So am I a "naysayer"? Only in the sense that the enormous, monolithic, IT projects that the LSP program has landed the country with really don't make much sense to me. We have to move forwards but currently we are now totally dependent on large corporations who show no signs of flexibility or creativity.

The context...

andrew.fearn@nuh.nhs.uk

09 Nov 09 14:46

I've never been to Bury, I don't know anyone there and I don't know their services in detail... but I'm almost certain the dedicated, committed and hard working NHS clinical and informatics staff in the town have been slogging their guts out to try something new and deliver something ambitious. That deserves a big pat on the back from where I'm standing... not disparaging comments from people who don't have the conviction to include their names on their postings!

It doesn't matter what they've got now or what they had years ago - what matters is they've taken the first and most difficult step to create a new way to deliver care to their patients. Good on them, I say... and good luck for the future!

Good luck to Bury

18 Nov 09 10:02

I reckon they are going to need it. I am very happy that Bury PCT have gone "Live" with LRC1.9 as at long last we are going to see exactly what CSC/iSOFT have delivered. How it is working in a real environment.

But alas again it appears that they have not delivered the complete product promised more to come. What can staff at Bury PCT do now with LRC1.9 that they could not do before go live.

Please do not patronise the brave resourceful and dedicated staff at Bury who have bravely taken the first step. The clinical staff I have spoken to are extremely worried about the impact the deployment of LRC1.9 will have on service delivery.

I expect now that CSC can tick the go live box the massive resources that Bury PCT were supported with will now evaporate. Ask South Birmingham PCT about post go live support.