Milton Keynes' Cerner implementation postponed

Tags: A Cerner Fujitsu House of Commons Millennium

06 Oct 2006

Milton Keynes Hospital NHS Trust has had to postpone its implementation of a new Cerner Millennium patient administration system at just three days notice, citing the need for more time to fix software glitches. The trust does not yet have a new go-live date.

The decision follows a similar last minute postponement of the project go live, which was meant to have occurred on the weekend of 14-15 August. EHI understands that staff had been rostered and booked leave around what was understood to be an absolutely firm date.

Milton Keynes took the decision to delay implementation on Wedenesday. A spokesperson for the trust told E-Health Insider: “During testing leading up to the original ‘go live’ date a small number of software problems were identified which have been corrected. To enable final testing to be fully completed the decision has been made to delay implementation and a firm decision on a ‘go live’ date will not be made until then.”

The delay at Milton Keynes raises doubts over whether Fujitsu can deliver on its stated objective of installing Cerner Millennium in ten more trusts by the end of the Calendar year.

In July Fujitsu told the House of Commons Public Accounts Committee that they would complete 12 installations of Release Zero of Millennium by the end of this month.

Of the twelve, two have since occurred – Weston and Mid Bucks – while the remaining ten trusts have told E-Health Insider they plan to go live with R0 by the end of the year. The next in the queue was to have been Milton Keynes, by far the most complex installation of Millennium yet attempted in the South.

In total Fujitsu has so far delivered three installations of Cerner Millennium, with Nuffield Orthopaedic being the first trust to go live in December 2005.

Readers Comments

Sounds worrying

drgordon.caldwell@ntlworld.com

06 Oct 06 21:58

This sounds worrying for any other Trusts about to go live! Surely minor software problems do not cause this sort of delay?

NPfIT/CfH Website

hilldunnassoc@btinternet.com

07 Oct 06 16:12

Wouldn't it be nice if the NPfIT/CfH website gave us details of implementations which have been completed and/or postponed? The '12-week forecast" bit at http://www.connectingforhealth.nhs.uk/all_images_and_docs/12wkforecast.pdf

gives a schedule of what is planned, but nothing about whether those planned implementations actually took place. Would anybody else like to see a supporting 'planned versus actual' summary (as I recall PRINCE2 suggests)?

For instance, the current 12-week forecast for the Southern Cluster suggests that the following acutes would go live for PAS as follows:

Buckinghamshire Hospitals Trust - 25th September Royal West Sussex Trust - 25th September

the dates for which have already passed, and a whole bunch of Southern Cluster Trusts are/were due to go live with PAS on 6th October. What is the situation with these?

Sleepwalking to disaster

09 Oct 06 10:00

I'd heard failure to link between Cerner Care Record and Cerner Choose and Book was one issue. Inability to produce adequate reports and letters another. And just how live are the Weston and S Bucks sites ? I'd heard that Bucks was only covering 1/3 of the Trust.

The whole approach always appeared heroic, and far from adopting PRInCE controls and balances. Not only are a whole bunch of R0 sites backing up, but the R1 sites behind them will be impacted by the mounting delays, and the toll on clerical and technical staff from repeated last minute deferrals is very wearing.

Whilst CfH may regard transparency as a curse, for those of us trying to plan to implement some ongoing and frank communication would be beneficial to the service, as the previous correspondant suggests.

Why so much negativity?

09 Oct 06 10:22

All most all comments that I have read on EHI over the past several months, relating to the NPfIT are negative. I tried to think of the various reasons why it could be the reason. Having personally seen some of the systems available, I believe that the comments are highly biased! I believe people hate the systems because they force them to work differently for one. Secondly, most opposition comes from the IT folks and information department staff. No surpises there, as they have lost all control and say over the process and in some cases those special trips to the various providers that they would have had, had they commissioned the systems individually! I am not saying that the systems available are perfect. However, if given half the chance and the money that is usually spent on procurring IT systems for the NHS, the systems provided by the LSPs will do the job and even better the current versions! If you look at the Millennium system closely, you will find that it fulfills almost all the high level policy agenda that the government has set for the NHS! It also works in the favour of the patient! For once guys (and ladies) think of the patient! The systems are being designed around the patient and not around IT staff! Get real! Customer (read patient) is the king. Work with the patient's interest in mind and not petty politics about should the IT departments have had a say in the procurrment or should they now have a say in developing them further!

Re: Why so much negativity?

09 Oct 06 11:25

In answer to the previous correspondent, I suspect that the negativity he percieves would stop if much more information were made available, not only about the failures and delays, but also about the successes - and particularly in relation to the replacement of PASs. For instance, we haven't yet seen one single fanfare of triumph akin to that which accompanied the successful Wirral Integrated Clinical Record Project, and similar, in the 1990s. Instead, we have a deafening silence (NOC and Mid/South Bucks), and postponement of a 'Lessons Learned' seminar (in the case of the Weston Super Mare implementation).

Cerner Millennium (and the comparable iSoft offering) may, as the last correspondent suggests, be perfectly fit for purpose, and may also be better than existing systems both for staff and for patiients. But it's clear that some NHS organisations - and not just the IT folk - don't agree. Rather than being negative, I believe the Milton Keynes folk should be congratulated on taking the decision that the system they were being offered, and had tested, wasn't ready for implementation. I'm sure this decision wasn't taken lightly; after all, had they implemented, they would no doubt have begun to make savings on the cost of maintaining their existing system.

Re: Why so much negativity?

john.bishop@leics-his.nhs.uk

09 Oct 06 12:08

Do!You!Work!For!Yahoo! ?

Reply to John Bishop re Yahoo

09 Oct 06 12:28

John,

A strange question, but if is intended for me (as the preceding correspondent in this thread), then the answer is no, and nor for any other ISP! Must admit I'm completely foxed as to why you ask!

Negativity for a reason

09 Oct 06 12:28

Firstly, EHI provides a unique opportunity. It is practically impossible to engage with CfH and LSPs in open debate. There is much spin, and less substance to the few 'official' documents that come outside the secrecy veil.

Secondly, I very much doubt that Cerner fulfills "almost all the high level policy agenda". These may be being debated by the great and good, but the system certainly does not cover the needs of or integration with GPs, community staff or social services. And it seems increasingly unlikely to provide a paperless and integrated solution.

And from the scant reports coming out of live implementations, they are highly traumatic, particularly for clerical staff.

The notion that NHS IT staff yearn for 'special trips' is facile. It is very useful to see how others have implemented systems, and get beyond the sales patter to the realities of pain and benefit. But locations and schedules were far from exotic, and CfH could have learned from not ignoring such opportunities.

And whilst your correspondent may not have noticed, it is the local information and IT staff who are being called upon, mostly without any additional resources, to keep the current systems going, simultaneously with preparing the data, training and transferring over to the LSP solutions.

All the measures we carefully ensured in previous procurements to be covered pre-contract, or made a clear supplier responsibility, have been dumped on us by this rushed and centralised process.

NHS based IT staff try and balance the needs of clinicians, administrative staff, Information output, and making it all work together, and act as agents for change, free consultancy and juggling all the priorities. And this is the thanks we get.

This appears an awful deal getting daily worse. I am an advocate for what the patient and taxpayer gets, and always have been.

If I tried to undermine clinicians in this way, I would rightly be lynched.

Reply to John Bishop re Yahoo

john.bishop@leics-his.nhs.uk

09 Oct 06 12:45

It was a slighty understated comment on the number of exclamation marks in the original posting. Yahoo are famous for doing the same (as pointed out ad nauseum by the register web site)

Reply to John Bishop!

09 Oct 06 13:27

Ah! That explains everything! But I can only see one exclamation mark in the original post! Are you reading EHI in DOS??!!

NPfIT/CfH Website

09 Oct 06 14:19

I agree it would be useful to have such a summary of implementations rather than to have to guess from changes in the 12 week implementation schedule followed by announcements on this site. However as it would just be another stick for those out to get CfH then I guess it won't be happening anytime soon. But the latest implementation plan implies that Cerner might now be implemented at Surrey Hapmshire Borders trust, Surrey Oaklands Trust and North West Mental Health Partnership Trust. I hope that is true rather than the implementation being pushed back past the 12 week window like it seems to have been done for Gloucestershire Hospitals Foundation Trust and South Devon Healthcare Trust.

Why so much negativity?

nhstechie@btinternet.com

10 Oct 06 08:55

I will treat this as an honest and simple question and try to give an objective response. IMHO there are two distinct groups within the NHS HI Community which produce much of the negativity: -

A) Those who thought NPfIT was a flawed concept from the outset. Many of these assumed, or were told, at a very early stage that the programme would never get off the ground and decided that like so many other central initiatives it would all blow over and wasn't worth wasting valuable time on. In many regions, because of this assumption, the draft proposals were not widely circulated amongst IM&T staff when sent out with a request for comments to all Trusts and Health Authorities via the Chief Execs bulletin and DoH Region Heads of Information (remember them anyone?) way back in 2002. This group were never effectively engaged in the programme and includes many colleagues within the NHS (for whom I have the utmost respect) at the leading edge of HI development and deployment who felt excluded and therefore disaffected from the outset. Whatever CFH say or do to remedy the situation this group are now so disaffected that many of them will never see any good coming out of NPfIT. In their eyes it will always be delivering too little, too late at too high a cost.

B) Those whose initial, often zealous, enthusiasm for the programme has been severely eroded by the widely publicised problems encountered by CFH (of which many of them have personal experience), particularly the delayed delivery of fit for purpose fully-integrated software suited for the UK market but also by shortcomings in CFH communications from a very early stage.

I am told anyone working for or with CFH has to sign a non-disclosure declaration - which explains why we never see anyone with a CFH email address participating in these exchanges of comments and providing an informed balance to the negative views.

There are other obvious groups outside the NHS who either have commercial axes to grind or who suspect NPfIT is a white elephant on which billions of pounds are being lavished with no discernible public benefit.

NHS CFH website

steve.finch@cfh.nhs.uk

10 Oct 06 14:12

The Southern Cluster is currently compiling a full list of all deployments to date by actual organisation/location, not just for the NHS CRS foundation release, but also for the numerous PACS, RIS and CR deployments that have taken place. This will be published to the www site shortly.

In the meantime, information for NHS members of staff can be found at: http://nww.connectingforhealth.nhs.uk/regions/southern including information on the various workstreams, technical delivery and deployment as well as a weekly news update. southernclustercomms@cfh.nhs.uk

NHS CFH website

10 Oct 06 16:16

I look forward to seeing the summary for the Southern cluster as described - it will help keep in mind what has happened to date and also must signal some confidence that there is a lot more to come.

More negative comment?

10 Oct 06 16:20

I know this will be viewed as more "negativity", but from the Primary Care section of EHI today...

"Nick Dunaway, director of IT (South Birmingham PCT) told the board that the poor performance (in relation to Choose and Book targets) could be attributed to a number of factors including low GP commitment in some practices, a dispute with the DH on the basis of the trajectory and the introduction of new patient administration systems (PAS) in Birmingham hospitals by Connecting for Health.

The report adds: “On Trusts previous PAS systems the call centre operators would normally have to navigate between 3 and 4 screens in order to register the patient, add the referral and then make the booking. This usually took between 3 and 7 minutes. Unfortunately the introduction of the new PAS’s has had an adverse impact on this process which now takes an additional 8 – 10 minutes, therefore the average time it takes to make a booking has increased to around 16 minutes." '

Now remind me. The correspondent in this thread who started this "negativity " debate suggested that the current CfH systems would "do the job even better than the current versions'. Is he/she still so sure? Presumably, unless the call centre staff referred to were idle most of the time, they now need twice as many call handlers as a result of implementing C&B with the new CfH PAS - which was supposedly designed with C&B in mind - as they needed for the 'legacy' PAS, and for which C&B was a cobbled bolt-on?

NHS CFH Website

10 Oct 06 19:25

Thanks Steve, it is good to know someone in CfH is watching and hopefully listening.

It would be useful to see an honest appraisal of the delays and issues that are being faced. The 'lot more to come' is a lot more pain for most of us.

The experience of Choose and Book does not bode well.

There are benefits but even more disbenefits

11 Oct 06 09:13

Never mind the wider NPfIT debate – the specific issues around the Cerner implementations are around patient management and reporting rather than potential clinical benefit – which do exist.

For example within an outpatient attendance you would normally record the patient arrival, the time seen by the consultant, record the intervention details, outcome, either close the outpatient episode or book a follow up or admit and as part of the process record any outpatient procedures that took place. You would think the system would include a workflow around the previous process. Not so I’m afraid – it is easy to miss out parts of the attendance and in terms of coding – you have to open a separate coding screen, select the patient and attendance and then encode. This process both enables data to be missed and takes around twice as much time as legacy PAS systems built around these basic patient management requirements within the NHS in the UK.

This is an example that illustrates the fundamental problem with Cerner – it is clinically rich, patient admin poor. Why so – well it’s obvious – given where Cerner has come from. It has been built to support a different healthcare model.

Now if only there could be honesty about this between the Cluster/CfH and the supplier and local deployment teams and time taken to get the system fit for purpose in these patient admin and reporting processes. But the NHS signed up to implement as is – so the NHS is at fault here. Therefore any fixes in these areas that lead to delayed implementations will cost the NHS. So the NHS hierarchy is putting immense pressure on local teams to get on with it, to work around such shortcomings – even where this adds costs or affects the performance of NHS Trusts. It would be interesting is someone (EHI) asked Weston questions under FOI re the additional staffing costs since Weston went live, what was the coding backlog at go-live, what is it now etc.

Not only is there a problem with the application and patient management – but there is also a lack of technical environments to support the domain based approach. Again using Weston as an example – for Bath to go live would require a significant period of downtime for Weston – ditto in other Domains when more that one go-live will be required. Most of the R0 Cerner deployments are reporting an inability to get on with the job due to unavailability of the environment due to the activities of the other sites within the same domain. This is another example of where costs were pared back by the NHS leading to a lack of capacity to get the job done.

Finally training – some bright spark signed up to a generic training environment rather than one based on a local build. This in turn leads to generic training rather than local process based training based on a local configuration. This has caused such a mess in Weston and is one of the greatest risks flagged in other deployments – but again is a result of the contract being pared back by the NHS.

Overall PACS has gone well in the Southern Cluster and should be celebrated. But until there is honesty about the problems with the Cerner implementations people will continue to use this forum as a means of getting real rather than spun information to NHS colleagues. In the meantime the hype, spin and denial is leading to ever increasing cynicism at the sharp end of the NHS who have been working their cotton socks of to try and implement replacement PAS systems. All they are asking for is a fit for purpose application, technical environment and training environment so they can do their job successfully. After all it is in nobodies interest to have a disastrous go-live – is it?

RE:There are benefits but even more disbenefits

11 Oct 06 10:31

I have to agree with the majority of the above post that there is a large amount of frustration from the NHS side regarding the solution being delivered, but I would also counter that with the fact that there is also a large amount of frustration from the LSP's side. The LSP's have entered into these contracts in good faith with the intention of deliverying against the CFH requirements on the assumption (I know very dangerous) that those requirements are those required by the Trusts this solution is to be delivered to.

It is therefore very unfair that LSP staff have to take the considerable amount of abuse and lack of professionalism from the NHS staff that they work with in order to deliver this solution.

If the trust staff dislike the solution so much or are concerned regarding its functionality then they need to raise these issues with CFH and not with the LSP's deployment staff who are powerless to change anything without CFH sanctioning it.

In order for this program to work everyone from top to bottom needs to understand the structure and contractual position of the program and where and with who the responsibilities lie.

i.e. As per a traditional model the Trust is the Customer, CFH are the supplier of the solution and the LSP is only a sub-contractor.

And back to the previous comment, I do not believe nyone who works for any of the LSP's including the now departed Accenture ever wants to see a disasterous go-live that is why the LSP's have worked very hard and in some cases bent over backwards to support these difficult situations without receving any additional funding from CFH even though it is above what was contracted.

Circle of blame

11 Oct 06 11:28

From the two comments above; "But the NHS signed up to implement as is ? so the NHS is at fault here. Therefore any fixes in these areas that lead to delayed implementations will cost the NHS. "

er CfH signed us up. The 'As is' was only for release 0, and many Trusts took one look, and said "no thanks, no way".

"As per a traditional model the Trust is the Customer, CFH are the supplier of the solution and the LSP is only a sub-contractor."

Show me the contract. CfH is the customer, the Trust are just the unwilling bride in the arranged marriage.

"It is therefore very unfair that LSP staff have to take the considerable amount of abuse and lack of professionalism from the NHS staff that they work with in order to deliver this solution."

The LSP arrangement has taken all control from local organisations, and it is the LSP who chose IDX and then Cerner (with limited NHS involvement). Some of us knew from previous US imports how dire this would all be. Is it more professional to pretend that everything is OK, or get this openly debated. And sorry, we know our users bite. Their main job is healthcare, and the IT should be a tool which just works first time, every time, and efficiently. From the above, the NCRS (And C&B) clearly do not.

RE:There are benefits but even more disbenefits

13 Oct 06 19:45

Couldn't agree more - all of the LSPs have had to try and deliver stuff that is outside of their contracts in order to meet individual Trust's needs. The abuse that LSP staff are sometimes subjected to is unwarrented, unprofessional and does not help achieve Trust objectives in signing up to CfH/LSP Projects.

I do work in NHS IT and am often embarrassed by the parochial outlook of many of my colleagues. We know that there are problems, but we should accept that this programme has to be successful if the NHS is to deliver a quality service to our patients. We should take ownership and drive through the solutions to these problems instead of only offering mindless carping.