Problems reported at Morecambe Bay

Tags: Connelly CSC iSoft Lorenzo Morecambe Bay

29 Jul 2010

Staff and patients at University Hospitals of Morecambe Bay NHS Trust are reporting issues with the Lorenzo electronic patient record system that went live at the start of June.

At a board meeting last Wednesday, staff side representative Kirk Panter said staff were having problems adapting to and using the software.

He said: “I have heard from employees that some staff are having to stay behind an extra two hours after their shift just to put data into the system.”

Comments published on the North West Evening News website suggest patients have also experienced problems.

One poster said: “Staff were frustrated as they could not access the system to look at the notes, results of tests carried out by the GP, or referral letter.

“The referral letter was never found and I had to explain the reason for the visit. Blood test results were not available so these had to be repeated.”

Another said: “I know several people who are waiting for now non-existent appointments due to this appalling waste of time and money.”

Last year, Christine Connelly, the Department of Health's director general of informatics, set a deadline for Morecambe Bay to go live with the latest version of Lorenzo – Lorenzo Regional Care Release 1.9 – by the end of March.

Local service provider CSC missed the deadline, although the trust finally went live with the iSoft system later in the summer. It now appears to be having issues with its legacy patient administration system, iPM and with feeding information from iPM into Lorenzo.

A presentation given at the board meeting identifies a number of issues including “data migration fallout from trying to shoehorn iPM into a rigid RTT structure,” and backlogs in translating referrals into episodes of care. It also lists “inconsistent behaviour being exhibited on occasions by Lorenzo.”

The presentation by Patrick McGahon, director of service and commercial development, shows that twenty staff are still dedicated to keying transactions into iPM, and that the data is being replicated into Lorenzo.

It shows that although the number of system issues is reducing, the number of data issues is increasing. However, it attributes this to users attempting to do more with the system as each week goes by.

In a statement issued to E-Health Insider, McGahon said: “Lorenzo went through a testing regime that included a wide range of users.

"As we were an early adopter of the system, we anticipated that there would be issues that would be identified when the system went live in a hospital setting with real staff and patients.

“Our staff have been extremely proactive in reporting any issues they come across and also ideas about how we can improve the functionality of the system. If we can fix it internally, we will do this immediately.

"Those that require external support will be done as soon as possible but we do provide a ‘work around’ in the intervening period.

“We are continuing to work through the issues that have been identified. The regular system updates we are receiving from CSC provide us with the fixes to many of the issues that are reported.”

The trust has said that it will continue with plans to roll-out Release 2 of Lorenzo to support emergency care, with a provisional go-live date of Tuesday 7 September.

It will follow this with the go-live of ‘to take out’ (TTO) medicines and e-prescribing on one ward at Furness General Hospital in mid-October , with four more wards across the organisation to go live by mid November 2010.

Links: North West Evening Mail: NHS staff in glitch claim

University Hospitals of Morecambe Bay NHS Trust: board meeting, Wednesday 21st July 2010.

Sarah Bruce

NHS Bury yet to sign-off on Lorenzo (25 Jun 2010)
Morecambe Bay goes live with Lorenzo 1.9 (01 Jun 2010) (8)
New CSC deal hinges on Morecambe Bay (11 Mar 2010) (9)

Readers Comments

Almost as bad as Millennium then?

29 Jul 10 13:12

Sounds like a similar situation to London and the South, but not as bad from the sounds of it to me (read the previous EHI articles to compare for yourself).

So we have a report on NPfIT in a few weeks don't we? It would be spectacularly good timing for this to come out and then the announcement of the end of the programmes, wouldn't it? I'm led to believe that the whole future of the Lorenzo programme rested on the success of the Morecambe Bay implementations.

It seems to be the M.O. of the current administration to whip up public opinion using whatever truths or otherwise are to hand before getting stuck into cuts and this is fits the bill very well.

Where can I place a bet that NPfIT is canned before the year is out? I might even have a flutter on it being within the next month!

Quality

29 Jul 10 16:06

I would not support these two mad initiatives in any way, but with tongue firmly in cheek I ask were the processes prescribed in DSCN 14/2009 and DSCN 18/2009 employed at any point?

Where can I place a bet that NPfIT is canned before the year is out

29 Jul 10 16:10

.....why don't you ask all the good people slogging their guts out to make this work? See what sort of an answer you get!

sandpit

Neil.Bhatia@nhs.net

29 Jul 10 16:35

I don't have experience of large scale projects like this, but couldn't these problems have been predicted? Isn't there some sort of "sandpit" testing done prior to rollout which would have shown up these data issues, or at least hinted at them?

Or is it that the whole thing was rushed through to meet a deadline, sort of get it installed, tick the box, then sort out the mass of problems later?

Genuinely asking.

Surprise surprise

29 Jul 10 19:40

I have been involved in 1.9 for a while now. Including at Morecambe Bay.

I really hope that at some point someone senior stand up and says that enough is enough.

The software is terrible. The processes are long winded and click heavy. There is next to no data checking (for example... register someone as male and set them up as someone else's sister!). Icons change throughout the program. The response time is shocking. There are columns in tables with no descriptions. Nested tables lose their formatting so information is all over the place. I could go on and on.

If a 1st year programming student submitted this as a piece of work they would fail... simple... I am a Computer Science graduate with my own software business.

The excuse "this is work in progress".... or "it's evolving" just doesn't wash any more... how so much money can have been spent on such a badly written piece of software I will never know.

With regards to the sandpit question... there are that many different environments on different builds you never know which one to try stuff out on.... upgrades happen with no useful corresponding documentation.... some things get fixed... some things stop working.

Please... someone... stop hiding behind excuses..... accept that this is not fit for purpose. Cut your losses and use one of the pieces of software out there that actually work.

I realise that there will be a lot of fallout if someone does grow a pair of balls.... but it HAS to be better than pushing on with this waste of space.

Sandpit

29 Jul 10 21:36

In reply to the Sandpit testing comment.

IMO the problem from the off was the model of one size fits all rather than software development conforming to information standards to ensure interoperability between different systems.

Still - all of us with 20+years EXPERIENCE of delivering SUCCESSFUL healthcare IT projects were told we "didn't see the bigger picture"......

Re: sandpits and castles in the air

29 Jul 10 23:53

Yes, there were supposedly (awfully named) sandpits, but it seems from what I have heard that the testing done in them was so bound up in contractual niceties, and rigid test scripts that real users have not been allowed anywhere near them, or to wander freely into and expose those cul-de-sacs that only users can find.

Millenium appears to be a very American-focussed system, so the data structure is suited to raising bills American style, not counting patients. It has been around a long time, and had lots of extra bits bolted on over time. Which creates richness, but stretches the original concepts

Lorenzo we are told was built from the ground up, and has all the opposite problems, of being very raw and underdeveloped.

GP systems, and many of the lesser (but working) secondary care systems (for the last 4 years threatened with extinction, so poorly resourced) have had exposure and feedback from users over a long period, which has often been accepted by the supplier to enhance their offering, and keep existing customers, or in some cases paid for once and shared freely.

The NPfIT contracts removed or contorted these mechanisms, and with both LSP and NPfIT between the expert supplier programmers and the expert users and NHS technical teams, most of the 'yes of course we can change that' became 'it will cost you lots to change that', or under the original DG, rigid standardisation says change your clinical or admin process.

So the sandpit issues are more over who was allowed to play in them, and whether the castles they built looked anything like ones the NHS could actually use.

Transparency Please

30 Jul 10 04:34

Shall we hear from the other recent go-lives, in the interest of transparency, please?

The silence from the Royal Berks and the Newcastle has been deafening, but then again, a Code of Conduct on disruptive behaviour is in force.

System

30 Jul 10 08:24

I am sure all the necessary levels of testing would have been done and every angel of day to day operations were reflected in test scripts.

In my own opinion the problems were:

End User Testing
A bit of training issues, if there was a problem with inputting data this must have been identified in training and initial level of testing
Interoperability of two systems working fine in a test environment and working fine in a live environment are two totally different things
I am not sure what the roll out plan was, but the roll out plan should have been one department/ward rather then a big bang approach
Many PM’s have their own ideas of implementing things and don’t take into consideration what other manager’s are saying based on their level of experience and expertise.

Stating all this, I beg to differ from myself because a system can be 100% working fine in a test environment but when it’s expose to live data and patients in can go belly up once again due to lack of vision by the main stake holders.

Roots

30 Jul 10 08:58

With any large scale deployment issues will be experienced after go-live. If they are not then the system simply isn't being used.

However you have to look at the specific issues and drill down to the root cause before blame is attributed to different areas

Staff having to work 2 hours each day: poor system? poor training? unfamiliar business processes? increased workload?

No access to system: low availability? forgotten passwords? bad system functionality?

These may fall under different areas of responsibility so all parties including the trust may be at fault (but let's face it none of us posters really know)

The scattergun approach to resolving problems ultimately means that lessons are never learnt and improvements made for the next deployment.

Are you sure on your facts?

paul.stoker@nhs.net

30 Jul 10 10:22

Some of the statements about the sandpits are simply not true. A release that goes through the full NPfIT development lifecycle, as Lorenzo releases do, are deployed into one of a number of National Integrated Sandpits (NIS or sandpit) for multiple phases of testing. One of the latter phases of testing is Model Community – business process testing performed by real users. During the preparation for MC testing, test scripts are written which are reviewed by the NHS users, who are then invited in the to execute the tests. The results and any problems found are then reported back to the supplier. I’m not saying the process is perfect, I’m just saying some of the comments above are not correct.

Angels...

30 Jul 10 11:54

I realise it was probably a typo, but I'm now intrigued by the Angels of Day to Day Operations...

In reality, when you deploy large systems, no matter how much you prepare, you always have the niggles as the product settles in and the people who have always done things in a particular way to make theirs and their patients lives easier in the old systems, battle to find the most effective 'work arounds' in a new system... This isn't always functionality availability - it's often about 'I used to do this, so how do I do that now'...

At the end of the day, people whose primary focus is delivering care are asked to change the way they've worked as well as do their job... and that's always going to be a challenge, particularly when you're fundementally changing the way in which the whole 'system' works and not just one small area.

Perhaps you should cut these guys a bit of slack and give them the time to be what they are... angels of day to day operations!!

going live soon !

kevin.dockerty@bwhct.nhs.uk

30 Jul 10 12:17

Our trust is soon to go live with Lorenzo so watch this space.

To pick up the point about testing I can confirm that extensive testing is being done, and this has been ongoing for quite some time. We are, however, still finding issues !

Angle, Angels

30 Jul 10 13:16

I meant to say angle's not angels lol. I appreciate the fact that these people are changing the way how they do things but based on what is reported could be seen as lack of training, the interface between the two systems not working properly and all clearly points out to lack of testing.

Systems are meant to ease off the work load of people not increase them. Problems are for sure to be faced but the impact of these problems could then be classified as an initial problem or a major problem which could have been identified at early stages.

It’s the responsibility of the whole project team to ensure that everyone using the system knows how to use the system to its full capacity…

"Doing things differently"

30 Jul 10 17:16

Were any Business Processes actually examined and re-engineered at the trust?

If not WHY NOT?

Re-examining existing business processes in the most fundamental of things to do when implementing new systems - why do I find myself repeating this time and again and were the business processes in use the trust tested in the sand pit?

Again, if not why not?

And Big Bang approaches are high risk - we should all know that.

What about the Trust next door?

30 Jul 10 18:13

I know Morecambe Bay's go-live is now several months late (if not several years if you believe what was orginally envisaged as the NPfIT implementation timetable for acute trusts), but I'm really interested to know what's happening in the trust next door - Blackpool, Fylde and Wyre - since (and to be fair to them) they've previously announced a planned 10-week delay to their go-live with their non-LSP EPR. I think we should all be interested in watching this space towards the end of September.

At Last...

31 Jul 10 00:44

Think all readers of EHI have been waiting with baited breath and the doom mongers can't wait to pile in. Most of the posts here are nonsense, written from a pedestal of ignorance.

Lets be clear, a PAS replacement at an Acute Trust is a huge undertaking and inevitably problems occur whether NPfIT or not NPfIT. Problems occur mo matter where and no matter what system, usual problem suspects surface everywhere. Lets be clear, the only sensible way an Acute can roll out the PAS is big bang - to even suggest otherise (post 9) shows a complete lack of knowledge of the subject.

You shouldn't always believe what you read - especially in the North West Evening Mail.

Poor Reporting Again...

31 Jul 10 00:54

This is quite a poor representation of the facts. The implication in this story is that iPM is feeding Lorezno, it is not. There is no interoperability between the two systems. So the poster in post 9 can strike that off his list please. Also, its no feasible to do an Acute, ward by ward. Actually, probably better to keep your opinions to yourself as you clearly don't know anything about the project.

Lets be honest, no matter what system it is - it takes time to get used to it. Remember the fury of the clincians in Barts? when Cerner went in, a year later they actually said it was fine.

DSCNs (and a small point off topic)

31 Jul 10 07:51

Poster no 2 is too modest. The DSCNs s/he mentions are both about information systems and patient safety. Both are sponsored by CfH and for further information they say to contact Ian Harrison, Chief Safety Engineer, NHS CFH Clinical Safety Group. Could EHI do this and ask for comments, and the evidence the DSCNs were applied in a) this specific deployment and b) the national programme?

Small point off topic: NHS domain name guidance at http://www.connectingforhealth.nhs.uk/systemsandservices/addressing/domainnames/nhsuk_namespace_policy#two includes: “In choosing an e-mail name for your domain, it should be clear and nationally recognizable.”

NHS brand guidelines (http://www.nhsidentity.nhs.uk/all-guidelines/guidelines/primary-care-trusts-new-guidance/naming ) say“You must ensure that the name of your primary care trust (PCT) is written out in full - without the use of acronyms or abbreviations“. [The same is in the versions for other types of NHS bodies.]

I've seen on EHI @bwhct.nhs.uk and @erypct.nhs.uk. I didn't recognise either – Blackpool and Wylde, East Rotherham and Y....? There are often others in the posts which are similarly not clear.

Why is the guidance so often not followed?

PAS replacement???

31 Jul 10 16:10

So, Poster #17 - you thinks Lorenzo Regional Care Version 1.9 is a "PAS replacement"? So much then for the rest of what you say in your post.

Re: Barts

01 Aug 10 07:44

A colleague is still getting erroneous letters about non-existent appointments, but in any case what these places have is replacements for mid-1980's technology levels. A PAS is the most basic (but still very complex I grant you) level of EPR.

The expert rules, care pathways and plans, intelligent documentation etc are not there.

The OBS has not been delivered on from the patient's perspective in London. I can say that from personal experience as a patient at these places. Maybe 40% has been delivered and I'm being generous.

Not worth the money and I do hope the companies are paid in relation to what's useful and workable on the ground to clinicians and administrators.

Contractually and from an executive perspective I'm sure everythings fine though...that's where the focus has been as is the apparent M.O. of the companies involved. Keep 'em sweet up top whilst the organisation bleeds below.

Its a question of commitment

03 Aug 10 13:42

"...the apparent M.O. of the companies involved...."

Sorry but I have to disagree with this - I've worked for both the NHS, several of the major Healthcare IT software suppliers (all but one of them on fact), and I can tell you that the level of commitment seen in most of the NHS is a diabolical joke.

The staff of the supplier are regularly working into the late evenings and early mornings to get things done; they regularly work over weekends - including Bank holiday weekends. The commercial sector staff rarely get any of this time back and have virtually no home life during an implementation.

Do we see this level of commitment across the NHS? No - all we get is "it isn't my job", "I finish at 5", "I'm not doing that - thats a grade x job" and any other obstacle possible to put in the way.

Sorry but it's a question of commitment and actually WANTING the project to succeed - and a "can do attitude".

I'm shortly going to start a new job - in the NHS - because its a dammed easier days work than elsewhere in Britain today - the money is better than the commercial sector and the benefits are second to none.

NHS commitment

04 Aug 10 20:34

Yes, I recognise some of the jobsworth 9-5 mentality that poster 22 mentions, but having been there testing and encouraging for a member of my IT team over the last weekend doing a data conversion exercise, and having spent nights and weekends doing major network moves and other jobs in my previous hospital role (including spending the 1999/2000 millenium new year evening at work - what an overhyped waste of time), it is of course a gross oversimplification.

There are dedicated consultants that you will meet on the wards late into the evening and over the weekend, there are dedicated GPs who will give freely of their time beyond the hours you would expect. And there are others who won't.

Of course there are those who would argue that long hours don't equate to a healthy work/life balance, or efficient decisionmaking. But the work keeps piling in, and some tasks have to be done at dead of night.

So bring your skills and your work ethic back into the NHS. We need both :)

A cushy number?

06 Aug 10 00:51

I do hope poster 22 hasn't applied for a job on my time as he or sh's in for a major disappointment. We have an overtime ban, a shed-load of extra work to do (much caused by the fact we have an NPfIT PAS system which is upgraded on a monthly basis) and a recruitment freeze (which makes this comment academic!).

Given the current wave of government-inspired bashing of "hospital managers" (which includes anyone not in a white lab coat or nurses uniform) and the widespread and very real threat of redundancy I'm always pleasantly surprised to find my colleagues remain dedicated and professional.

Oh ... and the pay is pretty miserable too in comparison with other sectors of the IT industry but admittedly better than the dole!