Millennium problems at Taunton condemned by consultant

Tags: BMA Cerner CfH consultant Fujitsu Information iS Maternity Microsoft Millennium NAO Nicholson NPfIT Security Solution Strategic US

03 Jul 2007

Taunton and Somerset NHS Trust have delayed deploying Cerner Millennium software due to ‘severe security problems’, the BMA’s Annual Representative Meeting heard. The software had been due to go live the weekend beginning 29 June.

Calling for a public inquiry into the National Programme for IT (NPfIT), David Wrede, consultant obstetrician and gynaecologist, told the meeting last week: “We have had greater then a dozen go-live dates. I’ve just been told that 30 June has again been cancelled because there remain three to six absolutely outstanding and severe security problems with the software.”

He explained the problems were which were causing Taunton to delay deployment of the patient administration system: “Namely, if I put my name in to get my patient data you get all the health information of my entire family. There are 50 P2 problems. The maternity programme they originally showed us collected 10% of the data that was required from the old theme driven computer system and we now have to buy an entirely new maternity system to get the Millennium module to work.”

In a statement, the trust confirmed that the go-live had been postponed, but refused to elaborate on the reasons for this. “Taunton and Somerset NHS Trust has postponed go live of Cerner Millennium, the foundation release of the NHS Care Records Service planned for 30 June, in order to allow time for remaining final issues to be resolved.

“The trust believes it is in a good position in terms of local readiness and preparation and is working closely with Fujitsu to work through the issues. It will set a new date when it can ensure as smooth a transition as possible for patients and staff.”

Both Cerner and the local service provider for the South, Fujitsu, acknowledged the hold-up in implementation from 30 June and said they will continue to work with the trust to agree a new go-live date.

Wrede, a member of the BMA's Central Consultant and Specialist Committee (CCSC), added that pressure was being applied to the trust to take the NPfIT solution and not purchase another, by its strategic health authority.

He claimed: “The contracting of Cerner is nothing short of a national scandal, even if you buy a basic IT package from someone like Microsoft when you upgrade it you pay a small proportion of the original fee to upgrade it, every single upgrade of Cerner costs the same and trusts are not being allowed to exclude themselves from R0 which is unbelievably dysfunctional.”

A Cerner spokesperson told EHI: “There are a few things that we feel are important to note about the Taunton and Somerset R0 implementation - the first being that only a handful of issues have caused this delay. In order to ensure a complete R0 transition in the near future, we are working closely with the trust and CfH to make sure all stakeholders are ready for the go-live launch.

“Secondly, it is important to clear up any confusion on the cost of the software system. R0 and related upgrades are free to all trusts as part of the NPfIT. We look forward to continuing to provide support to the trust, as any new IT implementation requires flexibility and dedication from all parties involved in order to achieve successful service delivery.”

A Fujtsu spokesperson added: “Fujitsu is looking into the issues raised and will work closely with the trust, Cerner and CfH to address any concerns.”

Wrede told the audience: “We should have a public inquiry. The people who made the original Cerner contract should be brought to book and as Cerner Millennium R0 is not fit for purpose under any kind of consumer legislation we should throw it back in the face of the suppliers and tell them if they want the money, they can take us to court.”

The motion was carried by the meeting, despite claims that an inquiry was unnecessary from other members (see BMA votes for non co-operation on central records)

An NHS Connecting for Health spokesperson said: “The NAO conducted an independent review of the programme in 2006 (and it will be considered again shortly). Its report was agreed with the Department of Health and is an accurate record of the progress which had been made to June 2006. Significant further progress has been made since that date.

"Former health minister, Lord Warner, stated that a further review would neither be constructive nor helpful. The open public meeting which was chaired by David Nicholson [the NHS chief executive] on 26 January 2007, to which a wide range of members of the media and others were invited, provided the opportunity for a further case to be made for a review. No evidence was presented at this meeting. David Nicholson concluded to all present at the time that 'he had not heard any evidence to suggest a review was required'."

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Readers Comments

A step backwards?

03 Jul 07 10:27

Is it not true that problems with the functionality of Cerner R0 is causing a delay in the implementation of other clinical systems at the Trust? systems that are already proven across the NHS and could be providing real benefits on a daily basis...

At last someone speaks their mind

david.birch@ascend.demon.co.uk

03 Jul 07 11:14

I think anyone who has worked on the Millennium product, seen first hand the R0 clinical functionality (or lack of it) - and experienced Cerner's attitude towards constructive criticism from NHS IT and healthcare professionals, can only applaud David Wrebe's comments.

The Millennium product, with it's underlying financial based architecture, is a US solution aimed at a US market. People who have migrated systems like this to work correctly for the UK market are always in line for an uphill struggle.

The Southern cluster of the NHS appears large to us - but to an American based software supplier, 90% of who's client base exhibits a different business culture and working practices to the UK's NHS, there has been little visible willingness to listen and to modify the product.

Surely it is hardly a surprise then, that many who have worked on the solution (R1 & R2) and have identified many of it's shortcomings back to Cerner some months ago (take the 18 week wait reporting for example) that this has happened.

The Millennium product has required substantial independent re-configuration in the six implementations that have so far occurred for R0 in the Southern cluster. Fujitsu are still faced with the task of presenting the system to an unsuspecting user community - square pegs and round holes spring to mind. The product does not yet appear ready.

I think Fujitsu, if they haven't done so already, would benefit from holding their own internal review of how they got themselves into this situation because I can guarantee this will not be the last time this happens.

(post edited by EHI)

Mutual blame and mutual shame equals denial game

03 Jul 07 12:30

The NHS assessed Fujitsu/Cerner R0 as fit for purpose - and we are talking about people at the highest levels - both NHS and supplier.

The NHS at the sharp end says it is not yet fit for purpose, needs work arounds - adds to operational costs at a time of severe financial stress.

So what is the natural inclination of the NHS and Supplier at the highest levels - blame local NHS organisations for the problem - rather than admit that there may be problems or they may have got things wrong. This results in massive political pressure and commercial threats being used to force Trusts to get on and go-live - whatever the impact.

So all in all we end up with this daft denial game - and given the clinical potential of the Cerner solution - this is the real shame in all this. The only NHS staff with the confidence to shout out load is Consultants - who will not be sacked for being honest. Everyone else dares not speak out - just look at the carefully worded statements that IMHO frankly nobody believes.

My advice to CFH, SHAs, Fujitsu and Cerner is this: its time you really started recognising who your customers are - which are coal face NHS organisations, their staff and the patients they provide services for. In true Prince terminology - you are all senior suppliers - not one of you is a true Senior User - and not recognising this fundamental point means you will continue to let the NHS down.

(post edited by EHI)

Oh, well that's OK then.

03 Jul 07 13:12

"The open public meeting which was chaired by David Nicholson [the NHS chief executive] on 26 January 2007, to which a wide range of members of the media and others were invited, provided the opportunity for a further case to be made for a review. "

Well, so long as the media are happy with NPfIT, there shouldn't be any problems with business as usual.

Millennium Not Fit for Purpose

03 Jul 07 16:56

The earlier comments by David Birch are spot on. Millennium has been desgined for the US healthcare community where they don't have 'pending lists' and 'waiting lists'. It is these areas where the majority of the problems lie.

The software currently does not produce the correct correspondence, and allegedly affects in excess of 20,000 letters per annum in Taunton alone. These letters will need creating manually using Word software, the cost of which must amount to £500k per annum in staff costs alone. Add to that the clinical risk of typing up patient details or procedure information incorrectly and you have a recipe for potential disaster.

When will Connecting for Health realise that they are attempting to implement software which no-one wants? All NHS Trusts who have signed contracts to take Release 0 must be bitterly regretting their decision, although it may be cheaper for them to buy themselves out than accept the expensive workarounds and lack of benefits the software will bring.

Taunton not alone

04 Jul 07 13:40

I believe I read in these pages only a few weeks ago of all the problems being experienced with Cerner Millenium at Milton Keynes PCT. In the light of their continuing difficulties one can't really blame Taunton for being cautious. What I do find surprising is that another Trust (from memory was it Winchester?) has not acknowledged having any significant issues with the Millennium system. Is it that they have somehow found a way round the problems? Are they on a different release of the software? Or are they just keeping quiet about the true scale of difficulties they have encountered? If the latter, shouldn't ALL trusts using the Cerner product be encouraged to compare notes (publicly) in order to bring greater pressure on the suppliers to get things sorted?

Note from Cerner regarding security problems

04 Jul 07 15:55

"At the time of the decision to delay the Trust go-live there were no outstanding security issues. Cerner is committed to working closely with our partners, Trusts and CFH to ensure that security issues are addressed and resolved."

Clinical Risk with Cerner reported to CMO in November 2006

05 Jul 07 22:06

I reported CERNER Millennium to the CMO as a clinical risk to the whole of the NHS Southern Cluster in Nov 2006. The management of the commissioning and contracts in relation to the CRS seem to me to ahve been severely deficient. We are currently building a duplicate IT system parallel and duplicate to CERNER to return 18 weeks target data, because CERNER cannot collect 18 weeks audit data and reports!

(post edited by EHI)

Clinical Risks with Cerner

06 Jul 07 10:45

"The Millennium product, with it's underlying financial based architecture, is a US solution aimed at a US market."

This quote is spot on with many of the problems identified to date with Cerner. There are many issues identified already around R0 and R1 and there are some major hurdles to overcome with R2 in clinically complex areas such as prescribing.

Many of the issues identifed pose significant clinical risks but the most depressing part of the whole process to date has been the unwillingness of Fujitsu/Cerner team to constructively engage on changing the product to meet UK needs. Instead the focus is on English hospitals changing their work practices so work arounds can be found...

It must be in everyone's interest including the suppliers to ensure that the system is appropriate for English needs otherwise this project is unlikely to succeed.

(post edited by EHI)

Basic Requirements not Met

06 Jul 07 11:00

It's useful to know of further problems with Millenium. This topic highlights a fundamental flaw. The service does not meet some of the most basic requirements such as saving HCP time at pre-identified points throughout their business process. Doctors are valuable resources at approx £25 per hour rough average. It is simply madness to employ them to do administrative work such as hand writing discharge forms at 10 to 15 minutes a time. Worse when someone else has already collected the information but its sitting in a system unused. Cumulatively this and other problems are costing the NHS millions. The more time spent waiting for NCRS to be delivered, the more is wasted. We need to roll out a complete tested product in one hit within one year of procuring it and then refine it with minor modifications. Not a basic product being designed on the fly from problems noticed during roll outs. All current problems seem to stem from incomplete analysis in the early stages of the product and poorly defined requirements.

This is not an unrecoverable situation, NHS pull out the contract and stop until the requirements are met. Can we have some compensation for the millions being spent on work arounds and interim solutions?

Name and address withheld for fear of reprisals.