Connelly sets benchmark for November
04 Nov 2009
The Department of Health’s chief information officer, Christine Connelly, has spelled out the criteria against which progress on the delivery of the Lorenzo and Millennium care records systems will be judged.
This spring, Connelly said she wanted to see "significant" progress on the deployment of the 'strategic' systems in the acute sector by the end of November.
Evaluation of whether Millennium and Lorenzo have met the mark will take place from the end of this month, but deliberations by the DH and ministers on what action to take are likely to extend into 2010.
The four main criteria for both systems are: do the products exist? Are they robust and reliable? Have they been successfully deployed? And can they be deployed at scale?
In an exclusive interview with E-Health Insider last Friday, Connelly said: “In April I said I expect significant progress from suppliers by the end of November, so it’s valuable to publish the criteria.”
Connelly told EHI that it she did not think it was “appropriate” to offer an opinion on whether the two CRS products will measure up. She also declined to predict by when the evaluation will be completed and any subsequent actions announced.
She said the criteria were being published “in response to questions about how progress will be judged." Connelly said her team, together with strategic health authorities and trusts, will judge whether the criteria have been met.
During the interview, Connelly also said that a final decision on how to proceed would rest with the health secretary, indicating the DH is serious about the criteria being met.
In April, Connelly said she wanted to see Millennium deployed at another acute trust and Lorenzo deployed in 'a care setting' by November, with Lorenzo "working smoothly" across an acute trust by March.
The acute trust under the spotlight is University Hospitals of Morecambe Bay, which gave Lorenzo a 'soft landing' at Furness General a year ago.
With the evaluation set to happen in November, the fifth test for Lorenzo will be whether this is “on track” to happen. The evaluation will be based on contract milestones such as training staff and dress rehearsals.
Explaining how the whole evaluation process will work, Connelly said: “If all the lights are on green it will be a short process. Similarly if all are red. But it’s more likely to be a mixture of different colour lights.”
Pushed on what outcome she expected to see, Connelly demurred: “I don’t think it’s appropriate for me to speculate on the colours of the lights we will have then. I am confident that we have the right criteria to evaluate, though.”
She predicted that considerable discussion will be required on which lights are must be green and which red lights are show-stoppers. “The discussion will be on whether something is nearly there.”
“We will take outcomes to National Programme Board, then the NHS Management Board and make our recommendations on what to do next. Ultimately it will be the Secretary of State who will need to take a view.”
Asked by when the evaluation will likely be completed and a course of action agreed, Connelly declined to be drawn: “I’m not going to say by when, there are too many variables. But its not gong to be the first of December.”
Instead she gave a clear indication the evaluation and deliberation process is likely to take time, stretching into 2010. “There is every possibility that people will ask for more information. This is a very big and complicated programme.”
The five success criteria published specifically relate to progress with the delivery of modules, criteria and milestones specified in LSP contracts.
Asked whether the DH will publish excerpts of the contracts to enable the evaluation process to be more open, Connelly said: “I don’t know, we generally don’t release elements of contracts as it’s not fair on suppliers. I’d have to speak to suppliers and get them to agree.
“But our intention is to be as open as we possibly can be here. We want to ensure we are involving all of the stakeholders in this process.”
The DH’s CIO acknowledged that six years into the multi-billion NPfIT it was less than ideal to be asking about the very existence of the main CRS products.
“The Public Accounts Committee said you should give suppliers a set amount of time to deliver. That’s what we are doing.”
However, Connelly said that in the case of iSoft she was not looking for alternative or existing products: “Lorenzo 1.9 is what we are asking for.” She also said the review "increases the chances of success."
The criteria were published in the same week that Connelly announced her intention to run a series of ASCC procurements in the South of England for clinical systems, beginning January.
Link: Department of Health publishes criteria for successful introduction of Electronic Patient Records
Jon Hoeksma
|
© 2009 E-HEALTH-MEDIA LTD. ALL RIGHTS RESERVED.
|
1 Precurements to start in Jan.04 Nov 09 12:22
This plan is flawed as it needs to find Trusts with a burning platform and more importantly a Trust with money to spend in the South. In this economic environment where will these Trusts come from (and the Conservatives want to cut administration budgets by 25%, and get rid of the big NHS computer thingy). 2 The pragmatic and self interest approach should be to support CFH and CSC right now.john.aird@uhl-tr.nhs.uk 04 Nov 09 14:52 Perhaps because we all felt so let down by NPfIT we seem to have developed a tendency to rubbish what anything happening now and the course being charted by CFH to move is away from our current predicament. As an Acute Trust IT Dir I think we need to put the problems of the past 5 years and our cynicism of CSC behind us. Yes I know we could rake over the problem and apportion blame and anger, but where would that get us- nowhere really. There are historic contract issues, but let the CFH lawyers and financiers address them, we need to be looking to the future of our organisations. A key element of NPfIT was that products are centrally funded. Yes I appreciate that CFH overlooked the substantial implementation and infrastructure costs, but those will exit regardless of what systems we employ. Right now we should have one eye on the money and looking forward there will be little of that to spare. Could we all afford to purchase alternatives to the full (eventual) Lorenzo EPR package? I would guess (hope) that CFH leadership is trying to ensure that Lorenzo is a workable product with a strong future ahead, enabling both CSC and the NHS to benefit. Hammering every little achievement as not being enough will not help us in the long run. But shear logistics, variety and complexity of the NHS tells us that one product or supplier will not meet the NHS' needs. Also, in the hiatus left by failed/late NPfIT systems other products and suppliers have emerged. So I would expect CFH to be actively pursuing alternative paths as well as helping CSC deliver a product with a future. Consequently I would argue that we should not paint ourselves into a “make or break” corner regarding Lorenzo being a flag waving success in the Spring of 2010. But see that as the start of the recovery. Also I doubt any CIO will not have been working up or implemented a Plan B, there are so many “interim” or "partial-EPR" options available now. Most are stopgaps to a full Darzi visioned EPR, but they are there. So lets not panic ourselves or make life impossibly difficult for CSC or ourselves, lets help them lean from their mistakes. After all, it is in our interest too. 3 CfH / CSC Bashing04 Nov 09 15:31 I have to agree with the comment from John Aird above. I beleive that after 5 years of NPfIT we have all become a little battle weary and find it all to easy to bash the partners in this project, almost as a default to any statement made. Yes, there have been problems and yes, there have been mistakes made but lets not forget the positives....... 1) PACS is in and working well 2) Many old green screen systems have been replaced with the long standing iSoft product of i.PM - which works well - and WILL migrate into Lorenzo which is an excellent system and is beginning to be deployed as intended 3) Many trusts have saved money because of the central funding I do believe that we all need to take a breath and look at where we are now in positive terms and move forward with a view to the exciting times ahead. 4 Trusts have saved money?04 Nov 09 16:25 I can save money by not buying food - but I will die. How many people's care has been adversely affected over the last 5 years which could have been better if we had freed resources for care by eliminating paper systems (like all serious industry supply chains)? Why have we not done so? Because we've all been waiting for CfH to deliver. Where could we have been without CfH and how many lives would have been better or saved? 5 Give people the credit they deserve04 Nov 09 18:13 It is great to see some support from a number of parties in regards to progress and the future. Yes at times there have been major delays and problems with NPFIT and some of the LSP's thought it would be a quick way to cash in. CSC also got it wrong in the begining but their commitment to the programme especially with a vendor who decided to implode for a while shows they really do care and many of the people who work for CSC are well respected people from the world of healthcare. There are a number of trusts who kept the faith and all you need to do now is see how Lorenzo pans out. Scrapping it now would be insane, a lot of blood and guts has gone into this and all of these "super" GP system we always hear about just help GPs to retain their monopolies but dont necessarily help patient care. Lets hope the news of Lorenzo 1.9 going live is good news and all of the grumpy people are finally proved wrong. 6 Paperless is not the issue04 Nov 09 18:37 The transition to paperless will happen by evolution not revolution. Medical notes are a complex function of a patient care within hospitals, nothing like GP Practice, nor is scanning the answer (to costly and does not remove the underlying practices or purpose). Paper notes will only go when clinicians stop using them, or feeling they need to. That will follow clinical and and nursing use being supplemented then replaced by integrated Acute/Primary information management (curtrently different worlds), very good hospital EPR's and cultural change. Meanwhile it is a red herring in this discussion.
7 PACS is not relevant to this!04 Nov 09 22:42 Yes, PACS is in and working well. It was also a mature deployed product in many Trusts before this project started. CfH and the LSP's have made a fast gain from PACS, by deploying existing, market tested products. That's great, but has nothing to do with providing Lorenzo or Millennium. 8 Re: Pragmatic & self-interest05 Nov 09 06:57 I have to disagree with John Aird. To continue to lend to support to the NPfIT / CfH experimernt - which has so manifestly failed in almost every respect - in my view it smacks of resignation and self-defeatism, though undoubtedly with some ongoing self-interest from those involved!
Personally, I believe it has failed, and will continue to do so, because the design of the programme and its outputs does not align to the needs of the NHS - a diverse collection of entities with an equally diverse set of needs, for most of whom the elusive "connectivity" promised by the national programme (and never likely to be achieved) is a much lower priority than caring for patients (and - of course - meeting targets). And we now learn that, in one case at least, experimenting with the programme's deliverables has meant missing targets.
Six years into NPfIT we have still not reached the "proof of concept" stage for most of its deliverables. Indeed most onlookers would probably agree that some concepts - such as the procurement model, the stakeholder engagement mechanisms and the wider programme management approach - have already been demonstrated to have failed. And that's before we start to look at the products!
This is - and always was - an experiment. It has failed and a radical re-think is long overdue. (post edited by EHI) 9 Lost the plot.. hope shouldn't be in the equation05 Nov 09 11:33 In response to comment 5s assertion below "Scrapping it now would be insane, a lot of blood and guts has gone into this and all of these "super" GP system we always hear about just help GPs to retain their monopolies but dont necessarily help patient care. Lets hope the news of Lorenzo 1.9 going live is good news and all of the grumpy people are finally proved wrong." I have two comments 1. Fundamentally 'hope' shouldn't even enter the vocabulary when we are talking about a project that is so large, so expensive and so critical - either it functions to an agreed specification or it doesn't surely! 2. GP systems 'work' have 'worked' for many years and do support patient care - how do they not? I really don't understand the comment about monopolies either - how is it proposed that Lorenzo or any other system for that matter could change what you describe as a monopoly situation. 10 looking forward to seeing Lorenzo at EHI Livemaryhawking@tigers.demon.co.uk 05 Nov 09 13:56 I'm looking forward to the demos of Lorenzo at EHI Live: maybe there will be someone there who can answer my questions about the information and clinical governance in SSEPRs! ;-> The more I think about medical records, the less convinced I become that even if the issues addresed in the RCGP report on SRPG (Shared Record Professional Guidance) *could* be addressed, the fundamentally different record needs of secondary care (unalterable record of care during a single episode of care for a single problem) and general practice (a management tool for an individual with multiple problems and a life-span of up to 100 years) could be encompassed in a single recored - or that, if the underlying theoretical model could be cracked, it would be usable. Really looking forwards to being convinced! 11 Lets get specific05 Nov 09 18:51 Dr Hawking You haven't replied to my explanation (in the thread where you won the award). You have stressed previously that your main concern with SSPERS is prescribing. I'll repeat the practical example On paper today - you are a GP and a consultant in the hospital wants to change the repeat prescribing regime for one of your patients. Currently, on paper, the consultant writes to you and asks you to change the regime. You then have the option to question the change or implement it. Now, on a shared record system - same consultant wants to change the repeat prescribing regime for one of your patients. how would you like the system to work? Option 1 - The consultant writes to you and asks you to change the regime, just as in the paper example. Option 2 - The consultant writes to you electronically (either by email or by using a feature of the system) and asks you to change the regime, just as in the paper example. Option 3 - You give the consultant permission to alter all or specific parts of the prescribing regime and you are notified wheneved it happens. It really depends on how you choose to use and configure the system doesn't it? How does EMIS web differ from this or is it just the same? Dr Pete
12 repeat prescribing - and Dr Petemaryhawking@tigers.demon.co.uk 07 Nov 09 16:02 Prescribing is not my only concern in SSEPRs - or even necessarily my main one - but it does illustrate the problems nicely. Take the problem of repeat prescribing and a hospital consultant wanting to alter the GP's repeat prescription regime. In options 1 & 2 the consultant passes his/her opinion to the GP and the GP accepts (or rejects ;->) the recommendation, implementing any necessary changes in the patient's regime and accepting legal accountability for the changes. In your option 3 (the consultant alters the repeat prescriptions), the GP may not be aware of the change, there may be problems with other medication not known to the consultant and who is legally liable?
It always sounds so nice and straightforward - but one of the questions in SSEPRs does lie with who is allowed to change medication prescribed originally by someone else and for reasons which may not lie within the speciality of the person making the changes. (of course, the consultant with full access to all the patient's records will be assumed by the courts to have full knowledge of everything in the record and knowledge of the management of all the patient's problems - but what about Independent Prescribers?)
As a GP, I am liable for any prescription I issue and sign - including those inserted by the consultant!
Medication management is an area of considerable risk for patients: how would option 3 decrease the current risks? And I am serious in looking forward to a demonstration of Lorenzo.
13 Nice to see some more reasoned commentsjk.ehi@knightnet.org.uk 09 Nov 09 11:47 I think that thanks should go to John Aird for putting out some sensible comments - too often CFH/NPfIT bashing is just too easy for people to resist. Personally, I cannot see the "NPfIT experiment" as a total failure, though some parts of it have been disastrous. The core concepts of a national messaging infrastructure, centralised patient demographics, national infrastructures for patient referals (Choose & Book) and electronic prescriptions, NHS staff identity management. Surely all of these have been successess. They are all implemented and they all work pretty well now. What, in my opinion, was a disaster are the concepts behind the LSP programme. We already had some good health IT in this country and really needed some help and direction to improve it further and get it more consistent and linked together. This could have been done with existing suppliers (and any new ones who wanted to join in), we didn't need to totally mess up most of the suppliers by killing their market for them and bringing in elephant sized corporations without the knowledge and flexibility to change along side an ever changning (and rightly so) NHS. It is good to see that there are still plenty of forward thinking Trusts that realise that "free" has an interesting meaning when it comes to the LSP world and that it can sometimes be better to spend the licensing money to get a better deal from more focused and flexible suppliers.
Regards, Julian Knight (IT Consultant) 14 And the problem is what ...?09 Nov 09 14:50 Dr Hawking So we're both comfortable with options 1 & 2 and neither of us like option 3 (it isn't my option - I just wanted to understand where you thought the problems were). I note that you've stated that the only working SSEPR is SystemOne. So if you can clarify your concern about SSEPR it would help all of us. Is it that SystemOne is implementing Option3 or is it that you just don't know how SystemOne works? Dr Pete
|
comments
comment
a friend