79 Milton Keynes staff say Millennium "not fit for purpose"

Tags: Cerner CfH consultant DH Fujitsu Green iS Millennium

04 Apr 2007

Seventy-nine clinicians and admin staff at Milton Keynes General Hospital have written an open letter to the management stating that the new Cerner Millennium system installed by Fujitsu in February is "not fit purpose".

In their open letter, the staff describe the software as "awkward and clunky" and state: "In our opinion the system should not be installed in any further hospitals."

Reported problems include clinics not being available, patient notes being lost or unavailable, staff being trained on a different system to the one implemented and problems with reporting around key areas such as 18-week waits. One senior clinician from the trust described the situation in outpatients as "a nightmare".

NHS Connecting for Health said that there had been "some unacceptable problems" with the new system installed at Milton Keynes which "require immediate attention".

The patient administration system introduced to Milton Keynes General Hospital five weeks ago as part of the Government’s £12.4 billion IT scheme for the NHS, was installed after repeated delays. The Cerner system is meant to provide the foundations for developing a Care Records Service (CRS) of electronic medical records.

The Millennium system replaced a 20-year old green screen system at Milton Keynes. The American Cerner system, supplied by Fujitsu, has been installed at five NHS trusts in the South. All are due to eventually get the same software.

In a statement Fujitsu said: "It is normal for new IT systems to have a bedding down period where issues are dealt with before it becomes a part of everyday working life. However, it is clear that in this case there have been some high impact problems and we regret any inconvenience that this has caused to patients and clinicians."

Cerner said in a statement to EHI: "Cerner continues to work with Fujitsu and CfH to address the issues and to support the Trust in addressing any remaining concerns following Go-live".

Despite that fact that all 79 staff who signed the open letter work for the trust Milton Keynes referred all press enquiries from E-Health Insider to NHS Connecting for Health.

A spokesperson confirmed, however, that staff had previously voiced their discontent and concerns about the new IT system through more standard trust channels.

Asked to confirm whether the letter did say that the signatories believed the system should not be installed in any further hospitals the spokesperson said "that is in the letter".

Local paper Milton Keynes News quoted hospital consultant Dr Richard Butterworth as saying. "Outpatients is currently a nightmare with no notes."

Dr Butterworth told a recent Board meeting that clinics laboriously set up on Millennium are no longer available as intended. "We spent months setting up new clinics but they are no longer visible on CRS. If these are teething problems that's great but otherwise I have concerns."

He is also quoted as saying that there have been problems with missing notes. "The new system meant that 40 patients had no sets of case notes". "It's much harder to see follow-up patients if you haven't got the old notes."

BT, which has the contract to deliver NHS IT upgrades in the capital, is also due to install the software in all hospitals in London.

MK News also quoted the trust's finance director Rob Baird as saying: "CRS is one of the biggest things that has happened in the organisation." He added that trust staff had worked "way beyond the expectations we could have of them"

He acknowledged that services had suffered though "The service to our patients in some areas has diminished in this period. At the moment we have quite a confused situation and it's like everyone had started a new job".

Baird added: "One of the problems was the system that we trained on was not the system that we went active with, it was a training version that was different." He concluded "We have found that in some areas it's not been as good as we would like it to be."

In a written response to EHI CfH said "Milton Keynes Trust identified some unacceptable problems with the newly installed system and raised these initially with Fujitsu (the supplier).

The agency said: "It is clear that there are some issues at the trust which need immediate attention and we share their disappointment that they have experienced these problems. Ensuring this is resolved and normal service is resumed is a top priority."

CfH said that having been informed of the problems by the trust on Friday 30th March it "responded immediately" and has set up a dedicated team to work through the problems.

The DH agency added: "There will be no payments made to Fujitsu until the system is working satisfactorily."

Fujitsu said that there were "16 issues" that had been identified as needing to be addressed after go-live, with six being of "greater priority". "They included case note tracking, re-scheduling out-patients and missing data fields. Fujitsu said five of the six, have been resolved and the one remaining is due to be resolved by the middle of April.

It added that three of the lower priority issues "remain under investigation and an on-site team from Fujitsu and Cerner are currently working with the Trust to resolve them."

Fujitsu promised that lessons would be learned from the Milton Keynes implementation "We continue to work closely with NHS Connecting for Health to rectify any issues as soon as possible. There are lessons to be learned from this particular deployment and we will ensure that these are taken on board for the future."

Readers Comments

Fire-fighting

04 Apr 07 08:01

IMHO, in a well-run IT programme, the "dedicated team" would have been deployed pro-actively. Why wasn't CfH taking a more active interest in the implementation of the system it was imposing through its supplier? Why did it have to wait to be informed on 30th March?

"Clinicians & Admin Staff"

04 Apr 07 08:58

Before reacting too strongly to this story it may be worth remembering that the NHS enjoys a constant struggle between managerial direction & the working practices/ preferences of clinical staff & their supporting admin . Perhaps the letter is a reaction, at least in part, to this resistance to change & may result from a lack of involvement of these staff in local, design decisions that now affect their day to day working. Perhaps not, but either way, I guess the "System" will continue to get the blame.

Successful partnership implementation is a journey

04 Apr 07 09:54

The methods adopted for NPfIT by CfH have ripped parts of the partnership working out. It has been very difficult to engage Clinical and particularly admin staff, and the Cluster appeared very resistant to suggestions that this was necessary.

And inbetween interminable delays, the speed with which worksheets are demanded to be turned around, the lack of ability to adequately query the context or implications of decisions, and the enormous numbers of "workarounds" required to make R0 function render meaningful local engagement very difficult.

Cerner may be a good system, but it has not been properly anglicised, and the 'ruthless standardisation' one size fits all approach imposed across the Southern Cluster appears to be proving a very bad fit for all.

Some issues, like putting the appointment time in a freetext area of the letter because it does not come through from scheduling make me despair.

79 of 2500 end users

04 Apr 07 10:55

Did the 79 bother to get involved with the project before go-live? Did they bother with training or are they just whining and providing a gory headline for the "we want blood" anti-NPFITers out there? 79 of 2500 end users thought they would show up on day 1 and everything would be perfect.

Gutsy Staff

04 Apr 07 11:14

IMHO the staff should be applauded for coming out and saying this. That other sites may have implemented it and not acknowledged similar failings seems astonishing unless of course Big Brother intervened before they went public...

Could somebody please tell me where the Patient is benefitting in the midst of this?

(Post edited by EHI)

79/2500

04 Apr 07 14:05

Just because only 79 / 2500 bothered to complain in writing doesn't necessarily mean that the others were content. And 3% of users is hardly a negligible proportion. Perhaps the other 2421 simply thought that complaining about NPfIT was futile?

Could somebody please tell me where the Patient is benefitting in the midst of this?

04 Apr 07 16:19

well, because of the NHS committment to choice, the patient could maybe choose to receive treatment at a Trust running on a stable, bedded-in PAS.

Seriously though, staff don't want to hold their hands up and say that this isn't right because they have families to support and mortgages to pay. Plain and simple.

No notes for follow up - no change there then

04 Apr 07 19:41

I'm sure that all GPs would share sympathy with the hospital consultant who feels that "It's much harder to see follow-up patients if you haven't got the old notes." This is a scenario that GPs are very familiar with - usually this is because the hospital letter or investigation hasnt reached the GP by the time the patient was told to go and see their GP. Today I was told by a local hospital that they havn't managed to get round to typing the letters from out patients appointment that happened at the beginning of March. At least if the patient goes to see their GP for follow up, even if there are no notes, they are more likely just take it in their stride.

As GPs we would share

I don't want to say

david.birch@ascend.demon.co.uk

04 Apr 07 21:19

I contracted for Fujitsu for three months last year to help set up clinical workstreams to configure the Cerner product. There were over 60 professionals int eh program working for Fujitsu at the time and everyone who came into contact with the product said it was not fit for purpose more than a year ago. Cerner, with their American mentality that the NHS Southern Cluster are small fry - and I am sure they are in Cerner's experience, made absolutely no efford to correct the shortcomings of Millennium within a UK NHS environment. It only surprises me that it has taken so long to get into the public domain. American software that's design goals are so radically different from the UK's ehtos, rarely succeeds without a complete re-write and the sooner Fujitsu and Cerner admit this, the sooner Fujitsu, as the LSP, will have a product to deliver that is fit for purpose.

Better than other deployments

05 Apr 07 11:21

I have reason to believe the Milton Keynes deployment was far better and gave FEWER problems than at some other sites which has never got into the press. Unfortunately, it makes a reasonable deployment look terrible. I have to commend all the IT, Information, Back Office, and Fujitsu (as well as TCS) staff who put a tremendous amount of personal effort into this. 79 dissatisfied staff (mainly clinicians) have probably been gunning for failure since day 1. Some of the issues are to do with legacy processes and operaional management. The change team put a huge effort into making sure the new processes would work but as usual - the people on the ground didn't listen at a crucial time and weren't managed effectively by their divisions during transition. Granted there are some issues but they are not show-stopping scenarios. Let's face facts some staff just do not want to change the way they work.

Change management

sleepyfox@gmail.com

05 Apr 07 13:53

The poster above says: "Let's face facts some staff just do not want to change the way they work".

Although I'm not familiar with the Milton Keynes deployment personally I have been working on the programme for the last 3 years and the thing I find curious is that there should be any change at all. Scenarios for change include:

a) A thorough business process management review is undertaken, and BPM experts together with Best Practice experts recommend a change to working practice that is approved by the appropriate administration or clinical bodies before being discussed, approved and championed withing the trust as part of a planned change programme.

b) A new IT system is brought in that is designed to work in a way that is different from the existing processes that a Trust works with. As is is too difficult/costly to change the IT system the users are forced to change the way that they work in order to fit the IT system.

In my experience of the programme most 'change' fits into B rather than A, in spite of the NHS's and CfH's vision statements for the programme.

Partly this is due to the large-scale, monolithic nature of the acute sector applications (CE, Millenium, iPM, iCM) that are deployed, none of which have been designed or built to accommodate change easily and at low cost. None of these applications were designed to elegantly handle the complexity of standards compliance that the programme is now asking of them.

It is my hope that next-generation products like Lorenzo will fix this deficiency and offer a more flexible/agile architecture for implementing NHS processes. Without this we will be limited to applications which work very well in someone else's environment (typically American) and not very well in the non-homogeneous environments we find throughout the NHS.

Not an 'open letter' but a 'round robin'

chris@cjsquire.plus.com

05 Apr 07 20:36

If this letter has not been published, it is not 'open'. It's not clear from your article whether you have seen the letter or not but you do not say where we can see it so I guess you are reporting a story told to you by anonymous sources.

The correct term for a letter of complaint with so many signatories that Authority cannot act against them is a 'round robin' [the names were signed in a circle round the text]. It is a sad reflection n today's NHS that its staff have to resort to such a tactic to make their view, right or wrong, known and even sadder that they did not dare publish as an open letter for all [and we are all paying for this fiasco] to read.

NLOP

06 Apr 07 21:21

I wonder what impact, if any, the hurried development of NLOP and the closure of the cluster offices (including the staff who should have been looking after the MK implementation) before the SHAs were ready to take on the implementation role had on this deployment?

Perhaps the implementation team had been made redundant or their short term contracts and secondments had been allowed to lapse? That has certainly happened in my cluster and SHA area.

No notes for follow up - no change there then II

06 Apr 07 21:25

"Today I was told by a local hospital that they havn't managed to get round to typing the letters from out patients appointment that happened at the beginning of March."

March of which year? The current record on my patch is seven months from hospital discharge to the letter arriving with the GP.

Can anyone beat this?

Challenge of Enterprise System Implementations

11 Apr 07 00:34

I acknowledge the comments above about the difficulties of large scale information system implementations. Of note particularly, the comments regarding resistance to change, usually driven by older clinicians that do not see the benefits (or want to).

But from my experiences in Australia, too often vendors are not prepared to acknowledge when their product does not meet the need. I have no doubt that concerns were raised by someone (whether it was someone within the 79 or not) at Milton Keynes regarding the clunkiness and general non-user friendliness of Millenium during the Implementation Planning proccesses. Too often these concerns go unheeded as the system's vendors chase the big bucks.