Morecambe Bay says Lorenzo now stable

University Hospitals of Morecambe Bay NHS Foundation Trust has told eHealth Insider it has stabilised Lorenzo and now has only a small number of outstanding issues with the software.

The position indicates a remarkable improvement from the position at the end of March, when EHI understands the trust had almost 600 fixes remaining for the iSoft electronic patient record, almost a year after going live with the latest version.

The trust told EHI that it has made steady progress since then, and that: “486 of the 537 issues at the end of March 2011 are fixed. This leaves 51 lower priority issues open awaiting retest on build 646.”

It went on to state that the software “has been stable since December 2010”. EHI further understands that the trust is about to stand down key project managers. The clinical leads in the project left at the end of March.

The trust is believed to be one of two on the brink of signing off on deployment of the latest version of the software, a key step in its contracted delivery by CSC, the local service provider for the North, Midlands and East of England.

Last week’s National Audit Office report, which was critical of the whole delivery of detailed care record systems to trusts, indicated that two of the three trusts that have taken Lorenzo were about to sign off on it; although it did not name them.

Asked whether it was about to sign off, the trust said in a statement last week: “Sign off of the deployment verification criteria is a matter for the Department of Health.”

Morecambe Bay is the flagship acute site for CSC’s deployment of Lorenzo as part of the National Programme for IT in the NHS. The latest version, known as Lorenzo Regional Care Release 1.9, was implemented across the trust last May. A stabilisation programme was launched in September.

EHI has been told in late March the trust still had almost 600 issues open, numbers understood to be broadly in line with the experience at two other early adopters, NHS Bury and Pennine Care NHS Foundation Trust – which eventually pulled out - by late 2010.

Although the trend had been downwards since December, with a sharp reduction in highest priority issues, a stubborn long tail of less pressing issues remained, with the number of second-order issues actually increasing.

A range of problems remained around medical clerking, appointment booking, and ordering tests and procedures. Work remained at an early stage on to take out (TTO) prescribing and starting to deliver other areas of clinical functionality.

One source told EHI that the scope of the Morecambe Bay project had been “severely de-scoped to give CSC a chance of hitting the March 2010 target date [for go-live that was set] by CfH”. TTO has been an integral feature of iSoft’s older iPM software for over a decade.

Conceived as a sophisticated electronic patient record system Lorenzo R1.9 so far remains primarily an administrative system, lacking clinical tools such as TTO medicines and A&E functionality.

In March, the trust was at risk of fines from its local primary care trust for being unable to meet a target to deliver 40% of discharge summaries electronically from Royal Lancaster Infirmary.

By the beginning of April, the number of electronic discharge summaries being produced was on an upward trend, but had still only reached 20%. Responding to questions from EHI the trust said the figure had reached 70% by early May.

Sources close to the trust however suggest that discharge summaries are not being generated automatically but instead rely on staff typing clinical and medication into discharge summaries. The Lorenzo system is said to still lack the ability to generate discharge summaries as a by-product of data already recorded.

Pennine Care NHS Foundation Trust, pulled out in April. Sources close to Pennine indicate that a factor that influenced the decision were problems experienced with core bed management functionality.

Following Pennine’s decision to pull out NHS CIO Christine Connelly said she intended to find a replacement trust.

Last week’s NAO report pointed out that even if the government decides to stick with the CSC deal in the NME, the LSP will have to work at an unprecedented scale to deliver on its current contract.

CSC has only delivered new systems into four out of 97 acute trusts in NME and would have to provide two a month to deliver in full by the end of the contract in 2016. No mental health systems have yet been delivered.

CSC recently told investors it was confident of getting a new memorandum of understanding from the Department of Health “within weeks.”

In response to a question from MP Richard Bacon, who triggered the latest NAO report, Prime Minister David Cameron said no deal would be done until the report was out and the Commons’ public accounts committee, the Treasury and Cabinet Office had time to consider it.

The PAC will hold a hearing on the report on Monday, at which NHS chief executive Sir David Nicholson, NHS chief information officer Christine Connelly, and senior figures from CSC and the other remaining LSP, BT, will give evidence. The Cabinet Office’s Major Programme Board is also reviewing the programme.