NHS CfH says spine now fixed

Tags: CfH Choose and Book DH GP Information integration iS NHS Spine PDS Solution Spine Standards

19 Jan 2006

NHS Connecting for Health, the DH agency responsible for delivery of the NHS National Programme for IT, has issued a briefing note stating that service levels have been restored to normal following service reliability and availability problems with the NHS spine over recent weeks.

According to CfH briefing note a normal service has been operating since 12 January 2006. Its latest briefing apologises for inconvenience the disruption the recent spine problems has caused to NHS staff.

As previously reported by E-Health Insider the NHS Care Record Spine and connected national systems, including Choose and Book and the Electronic Prescription Service, have been suffered from reliability issues following a troubled upgrade to the spine beginning 17 December.

A 2 January internal briefing note from CfH's Choose and Book team identified problems experienced by end users including "intermittent failure updating patient demographic information", "failure to automatically generate a patient password" and "occasional slower searches for patients".

The new briefing paper stresses the scale and complexity of the NHS National Programme for IT, being delivered by "an incremental series of software releases over time to build increasingly richer "functionality" to support patient care and clinical safety."

It goes on to state: "The upgrade release to the NHS Care Record Service over the weekend of 17 and 18 December 2005 was the largest and most complex to date. It is estimated that it involved around 3 million hours of IT development over the previous year by various suppliers. The upgrade involved major changes to the Personal Demographic Service (PDS)."

At the centre of the December update was the introduction of software to limit access to a patient's clinical record "to ensure that only those clinicians with a legitimate relationship with the patient could access the record".

The CfH statement says: "It is regrettable that our suppliers were unable to maintain full availability without interruption during the integration of the multiple systems that took place following the upgrade. It is also regrettable that the solutions do not yet appear to meet the exacting standards we require to support continuous working 24 hours a day seven days a week."

Identifying the specific issues that caused "intermittent interruptions" to the live service the briefing paper says these include:

• One of the existing suppliers of GP IT systems [understood to be InPractice Systems] had a defect in the way its system linked with the upgraded Spine. It meant that the system persistently and automatically sent high levels of erroneous traffic into the Spine. This caused “congestion” as data flowed round the system without making a connection and made problem detection difficult.

• The congestion described above together with intermittent slow response times and changes in the Spine upgrade made it difficult to use Choose and Book and the Electronic Prescription Service.

• In particular, the Choose and Book application, when generating a password for the patient to access their booking, did not link correctly with the PDS. An immediate improvement has been applied to the Choose and Book application and the permanent solution is due in February.

• Following diagnosis of the reported problems with the updated PDS service, a number of improvements have been made, including how information is written to the database.

CfH says that throughout the recent problems it has held "twice daily escalation and resolution dialogues with the suppliers involved" including during the Christmas and New Year holiday. In addition it says the issues were escalated within each of the supplier organisations "to ensure that the seriousness of the situation was understood and that priority was given to providing resources and expertise".

The NHS IT agency says that following recent problems it will be seeking additional assurances from its suppliers over how they will make their systems more robust and how in future we all ensure their systems interface with each other seamlessly. It also states that under the contracts signed the December spine upgrade work will not be paid for until there has been "a run of 120 hours normal continuous service".

Links

CfH keeps fingers crossed on spine

Choose and Book's problems continue

NHS suffering from broken spine

Readers Comments

Inexcusable

19 Jan 06 07:20

17th December - 12th January = 25 days to resolve a reliability issue! How did this upgrade ever come to be rolled out in the first place? Just what are the testing arrangements stipulated by CfH? And we are only at the very bottom rung of a highly complex implementation ladder for the full set of CfH aspirations. So let's hope that procedures are tightened before they attempt the difficult stuff.

Choose and BooM?

19 Jan 06 13:51

Is that a typo, or a better name for the system? (3rd Para of article) :)

Its a typo

jon@e-health-media.com

19 Jan 06 14:01

Err, that would be a typo... apologies about that.

Jon Hoeksma, editor EHI

Common sense, it's understandable

19 Jan 06 16:23

Nothing can really replace the enterprise performance and stability tests except the Live Spine system itself. The live data center is somewhere few of the IT system in the current world ever went into. I don't want to make it star-trek alike but Spine team is doing sth very few people in UK IT industry ever did, or even heard of. The deadlines are sressful and not many IT people would like to spend their Christmas time in the office, for the project!

Maybe later on, CfH could consider a Live Test Run period before it's really going for Live! Performance and Reliability issues need time to emerge.

Sense and understanding

19 Jan 06 17:55

That the live spine scenario provides the acid test is clearly true. However, my main point in the earlier posting was that if it has taken 25 days to sort out this early problem, then before more complex stages of CfH implementation are reached, it'd be good to have some better preliminary testing.

There are a couple of other comments arising from the last posting. Firstly, "going where no man has gone before" with the spine is worrying: what's the evidence that this mainstay of the whole CfH programme is a feasible technical proposition at all? Secondly, once it's rolled out live in the NHS it becomes a "service" as well as a "project" and health IT professionals will need to cover bank holidays (like porters, nurses, doctors and lots of other stressed staff). One might reflect, though, on the wisdom of project teams rolling out something new in the run-up to a holiday (unless "by the end of the year" was an important deadline).

Nothing New

20 Jan 06 09:02

When I started in IT in the NHS 16 years ago, we already had regional systems and data centres. There is nothing new or innovative about the spine.

Normal service

richard.james@falmouthhc.cornwall.nhs.uk

20 Jan 06 11:17

I was not consulting yesterday so missed my opportunity to use CAB. I see normal service has been resumed today. Oh well!

The novelty is its scale

22 Jan 06 16:21

If there is, as has been suggested, "nothing new" about the spine, why does CfH seem to be making such heavy weather of the initial stages of its implementation? Could it be that they have also assumed that it presents no challenges over and above the regional systems of the early 1990s? In reality, the present-day proposals for the spine are on a scale that far exceeds anything to be found in the 14 regions then in existence, with England-wide individual records holding clinical (rather than management) information, and with a far greater potential load on the system. Isn't the spine's main novelty its scale, and doesn't this of itself represent the main threat to successful implementation?

Nothing new... Are you sure?

26 Jan 06 18:22

I have to take issue with the above post. The spine (when it works in full at the end of the TEN YEAR program of NPfIT) will revolutionise patient care and information storage in this country.

I am not a member of the NPfIT board, nor am I paid by them to say these things. I am an IT Trainer who has trained in 5 different trusts to go live with Lorenzo. I can see the benefits. I can see that Non-NPfIT systems don't communicate cross-SHA. I can see that if a birmingham based patient went to Newcastle for a holiday and broke his leg then the Newcastle hospital would have to waste time trying to get in touch with the poor man's GP, when actually the spine stores that information.

Having worked in a large acute trust I was amazed that even some of the Hospital systems didn't communicate with each other, let alone with other organistations so come on, please! Nothing new? Its the most significant IT project in this country right now, if not in Europe.

I will be the first to admit that there have been hiccups (and some full throated belches if the truth be told) but it's a system in its infancy.

To answer another post, yes the scale of the spine is a novelty. The main novelty however is to get Healthcare Organisations from different areas communicating for the good of the patient. As more and more trusts go live with the system the benefits will be seen. Watch this space.

I was - and still am - sure

27 Jan 06 09:21

If if works in ten years time (not "when") then it may add some value. But - given other NHS priorities that cannot currently be met (see the newspapers daily) - is communicating between providers really worth all that money? Most healthcare is local, and it's hard to make a £6.2bn (and the rest) business case to support the sort of clinical scenario described above.

CfH is into its 4th year (not its infancy) and it should be building on the experience of a raft of previous NHS IT projects; it should also look more widely at other large IT projects, like the London Stock Exchange Kinnect paperless project that was terminated just this week! These big centralised projects have a high failure rate and the indications well into CfH's attempts are that it, too, will fail.

So, cancer drugs, cleaner hospitals, heart operations, pensions for NHS staff at 60? Yes please!

Another big experimental IT initiative (even if it's the largest in Europe) at the public expense? No thanks!

Spine not updated since November 2005

28 Jan 06 10:54

Very few Trusts and GP Practices are updating the spine which is still reliant for up to date patient demographic data on updates from the databases of the 300 PCT's in England. However these updates have not been applied to the spine since late November 2005. Consequently the data on the spine is becoming out of date.