Patient data errors created by iSoft's iPM system

Tags: A CfH CSC Data Information iPM iPM iS iSoft LSP NPfIT PAS PAS Solution

09 Jan 2006

A flaw has been identified in the iSoft iPM patient administration system being provided as the standard solution to NHS trusts in the North West and West Midlands that can corrupt patient data creating suspected clinical risks to patients.

Under certain circumstances the iPM patient administration system has been found to both incorrectly display patient referral data, and to also record a patient's referral data against the wrong electronic patient record.

NHS Connecting for Health correspondence seen by E-Health Insider states that problem has "suspected clinical risk implications", and urges trusts not to try and recreate the circumstances under which the problem occurs.

The iPM patient administration system is being supplied by Computer Science Corporation Alliance (CSCA) to NHS trust's across the North West and West Midlands (NWWM) cluster under the £6.2 billion NHS National Programme for IT (NPfIT). CSCA is the prime contractor responsible for delivering new IT systems to NHS organisations across the region under a £973 million contract.

The problem, which was first identified by NHS organisations in Greater Manchester on 16 December, appears to exist in all iPM implementations carried out in the region. An iSoft spokesperson told EHI that a fix had provided within two days of the problem being identified.

Mis-recording referral data to the wrong patient record has so far been identified in 40 patient records, out of 220,000 patient records examined. According to iSoft it has so far been "unable to replicate the problem outside of the cluster" and has "not had any issues logged oustide the NWWM cluster".

A version of the same iSoft PAS product is also being offered by Accenture, NPfIT's prime contractor in the North East and Eastern regions.

As of the end of December approximately 36 NHS sites in NWWM were understood to be at various stages of implementing the iPM patient administration system. CSCA, iSoft and NHS CfH declined to identify the specific sites affected by the problem.

A 20 December e-mail from the NPfIT regional implementation director Paul Charnley stated that following investigations, carried out after the problem was first identified: "It now appears that there may have been a risk with this piece of functionality since the first sites went live with iPM."

Charnley's e-mail goes on to tell health authority chief information officers that "iSoft and CSCA are working on a fix", and that overnight "scripts are being run to identify any further records that might become affected".

In its initial investigation of 220,000 patient records CSCA identified 40 potential incorrect patient referrals. According to Charnley's email all 40 instances known to be affected have been identified and the referral information for the patients concerned passed onto the local trusts concerned for verification.

As a work around specially written scripts are currently being run every night by CSCA, to identify errors and then notify the NHS trust concerned so they can take corrective action. Trusts notified of potential problems are urged to carry out checks that should involve "both electronic and patient records"

The documents state that patient data may be incorrectly displayed and recorded to the patient's record if what should be routine functions are used – either clicking the Referral View icon or Referral View option from the Context Screen of iPM.

"All testing to date suggests that not using either the Referral View icon or the Referral View option from the Context menu is the single most important step to take in avoiding this problem," states the NHS CfH correspondence seen by EHI. "We believe that the necessary functionality can be accessed in other ways, notably by right mouse click from the Patient View."

CSCA NHS CfH declined to confirm how many sites had ben affected or by when a full fix to iPM would be implemented. The NHS CfH email correspondence on the issue stresses the need to keep quiet on the problem. "We would also ask you to keep this information as confidential as possible."

A joint CSCA, iSoft and NHS CfH statement said: "On Friday 16th December, users in Greater Manchester identified an issue in the LSP reference solution which has resulted in a small number of referrals being associated with the wrong patients. The issue only manifests itself when the solution is used in a specific sequence.

"The CSC Alliance has investigated all such potential incorrect referrals and has identified a total of 40 out of over 220,000 records. Each of these 40 referrals is being investigated to ensure the correct information is associated with the individual patient concerned. The level of clinical risk has been assessed as low since all 40 instances known to be affected have been identified and referral information for patients is being verified in conjunction with local Trusts."

The joint statement concluded: "The CSC Alliance has identified a fix for the issue and the method of full deployment is currently being finalised. Scripts to identify any incorrect referrals will be run on a daily basis until the fix is fully deployed."

Readers Comments

risks of misidentification

Rod@RodSpace.co.uk

09 Jan 06 13:52

The statement that: "The level of clinical risk has been assessed as low since all 40 instances known to be affected have been identified and referral information for patients is being verified in conjunction with local Trusts." is not particularly rerassuring as there must be a risk that an unknown number haven't been identified & for them the risk could be high.

(post edited by EHI)

Is there a standards framework?

10 Jan 06 08:03

This seems critical to patient safety which begs the question of whether there a standards framework (tested and approved by the NHS Information Standards Board) for how patient identification is managed in CfH systems?

Secrecy - just the ticket

10 Jan 06 14:09

The edict to "keep this as confidential as possible" is not in the best interests of patient safety, or ensuring that users around the cluster are on the lookout for any problems with patient records missed by the automatic trawls.

Apart from the commercial interests of the suppliers, secrecy can only be damaging.

(post edited by EHI)

Secrecy abounds!

10 Jan 06 14:57

The need for secrecy seems to emanate from CFH throughout the whole process so the comment is not surprising really.

More interestingly would be the reasons why Isoft iPM software which has been around a lot longer than NPFIT/CFH is being implemented in such large numbers in NWWM cluster(and being offered in Eastern and North-East clusters) when everybody was led to believe Lorenzo was to be the offering and surely what was contracted to be delivered.

(post edited by EHI)

Has the NWWM Cluster any Success Stories?

10 Jan 06 23:48

2005 has been and gone! IPM PAS, Choose and Book and PACS, there must be some success stories in the NWWM Cluster under the CFH program to shout about....is there?

Successes in NWWM Cluster

jon@e-health-media.com

11 Jan 06 09:50

In response to the last post I think its only fair to clarify that E-Health Insider has never reported there are 'no successes' in the NWWM cluster under CfH. As the story above states by the end of December we understand approximately 36 installations of the iPM Patient Administration System had begun or were beginning in the cluster.

However, as the last post states, for whatever reason, CfH, and CSC Alliance weren't exactly shouting about them. One possible factor is that LSPs don't get paid for beginning an implementation until 45 days after they have reached an initial milestone.

Its the end that really counts ...

11 Jan 06 11:19

Beginning an implementation - whatever that means (maybe something as basic as writing a PID) - hardly constitutes a success story and so it's not surprising that nobody was shouting about the 36 installations! And these are only PAS systems when all's said and done. Perhaps the NWWM cluster could be more open about the precise status of each of these?

Secrecy

ewan@woodcote-consulting.com

12 Jan 06 19:35

Secrecy about system problems is clearly not in the interest of patient safety and I would suggest that it is also not in the interest of the NHS or system suppliers. Theses sort of problems have always occurred in both manual and computerised systems and are most likely to be reduced in the future if they are discussed openly.

However, I find it interesting (and sad) that those who complain about secrecy feel that they have to keep their identity secret in their postings here.

A possible explanation

13 Jan 06 09:41

People might - of course - need to remain anonymous because their organisation's won't let them comment openly. It'd be a shame to lose their insights.

Are they comparing the correct data?

pam.mckeown@geh.nhs.uk

13 Jan 06 09:43

The article states that CSCA identified 40 potential incorrect patietnt referrals in its initial investigation. I would be interested to know the selection process for the 220,000 records. If there have been 220,000 referrals to the sites with IPM and only 40 of these are wrongly attributed, it is a small but worrying percentage. But if the 220, 000 is merely records on the PMI, the figure I would be interested in is how many of the 220, 000 had referrals, and the percentage of these that were incorrectly allocated.

Roots of secrecy

13 Jan 06 10:08

Unfortunately, I think the root cause of the secrecy issue is the environment in which CFH and the suppliers are working in. In no other sector would the machinations of a project like this be open to such intense and public scrutiny. In many ways this is a good thing - it is public money after all. In other ways, it's not so good as it gives some poweful vested interests an excellent forum in which to put the boot in.

It's not good, but it's understandable. And of course, it plays directly into the hands of the critics when ham-fisted attempts at secrecy are exposed.

Secrecy - and error capture

mary.hawking@nhs.net

15 Jan 06 10:24

There may be reasons for secrecy about problems encountered in installing new systems, although I find it hard to think of one for this particular problem. Confidence in the whole program might be increased if there appeared to be any attempt at systematic collection and correction of such problems. For instance, does anyone know whether this error applies to all versions of the iSoft iPM patient administration system , to the version being provided as the standard solution in NWWM (is this version the same as the one being supplied in NE and E?) or is this a single site problem? My local Trust has been told it does not apply to them - but had to ask to get the information... Has everyone with the identical system been told anything?