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Bacon calls for halt on Millennium

19 January 2012  

PAC member Richard Bacon

Conservative MP Richard Bacon has called for a halt to all Cerner Millennium deployments following appointment problems and delays at the latest trusts to go-live with the system - North Bristol and Oxford.

Bacon, who has followed the progress of the National Programme for IT in the NHS for many years, said the two hospitals had been “brought to their knees” by the implementation of the new electronic patient record system.

“These deployments need to be stopped until we are sure that they can be managed safely,” he said; adding that the system should be "switched off" if it was not working for patients.

North Bristol NHS Trust and Oxford University Hospitals NHS Trust said they are working through some deployment issues, but denied that patient safety has been compromised.

However, Oxford University Hospitals told eHealth Insider that it has had to bring in extra staff to help it overcome some “temporary problems while the new system beds in.”

Bacon said local news reports indicated that the trust was having serious difficulties booking patients in for treatment.

The Oxford Mail has reported that problems were so bad before Christmas that the trust had to suspend its parking charges as clinics over-ran by hours.

But an Oxford University Hospitals spokesman said the level of disruption was anticipated with a project on this the scale of the Cerner implementation; and that it had planned the suspension of the parking charges.

He said the changeover to an electronic patient record was one of the largest operational changes the trust had undertaken for a considerable time.

“We acknowledge that some patients have suffered inconvenience and found it more difficult to book appointments whilst our staff become familiar with the system,” he said.

The trust is providing training, additional resources and support to help staff “get up to speed with the new IT system.”

It is also putting in place additional staff to help it “get over” the temporary problems, he added, insisting there would eventually be “many benefits” for patients.

North Bristol NHS Trust told eHealth Insider last week that “unexpected problems” following the go-live of Cerner Millennium had led to patients being booked into non-existent clinics or not told about scheduled operations.

In a regional BBC report, anonymous clinicians called the implementation a “complete shambles”. However, trust director of IM&T, Martin Bell, said patient safety had not been put at risk.

Bacon, who was instrumental in triggering last year’s National Audit Office and Commons’ public accounts committee inquiries into the programme, said the NHS should never have been locked into buying software that was “unreliable” and “unreasonably expensive."

“Effective, affordable and robust IT systems are vital to the future of the NHS, but it is clear that the fiasco that is the national programme cannot deliver them,” he said this morning.

He called for “a halt” to new Cerner Millennium deployments, including that at Imperial College Healthcare NHS Trust, which is being undertaken by BT as the local service provider for London, and that at Royal Berkshire NHS Foundation Trust, which went outside the national programme more than two years ago.

In a statement to EHI, Cerner vice president and UK managing director Alan Fowles said trusts were using Millennium to drive change and optimise services and processes which would “realise benefits over time.”

“We work in partnership with the NHS to ensure that any disruptions or problems during deployments are resolved as quickly as possible,” he said.

“Patient safety is always taken extremely seriously and together with our NHS clients we put extensive risk management measures in place when conducting any deployment.”

Fowles said he had invited Bacon to engage with Cerner “in order to understand the complexities of healthcare informatics deployment and the methodology used to ensure success.”

A spokesperson for BT, which won a contract to deploy Cerner Millennium to North Bristol, Oxford and one other 'greenfield' site in the South in 2010, said: "Patient safety is of paramount importance to BT in all of its work with the NHS.

"At our two most recent deployments at Oxford University Hospitals NHS Trust and North Bristol NHS Trust, there is no evidence of any risk to patient safety – something which both trusts have acknowledged.

BT is managing Cerner Millennium at 19 NHS trusts across London and the South of England, serving over 100,000 NHS users, and will continue to work with them to deliver the benefits these systems bring to staff and patients alike."

 


Related Articles:

1 News: Royal Berkshire plans March go-live | 13 January 2012
3 News: North Bristol hits appointment problems | 11 January 2012
9 News: North Bristol third greenfield live | 12 December 2011
News: Oxford live at second attempt | 6 December 2011
12 News: London Cerner costs now put at £31m | 3 August 2011
8 News: Nicholson comes under fire from PAC | 3 August 2011
3 News: BT's London and South deals defended | 24 May 2011
Last updated: 20 January 2012 09:51

© 2012 EHealth Media.


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Bristol often is a puzzle

It is I, LeClerc 147 weeks ago

In the begining Southmead , like the whole of the SW, had the excellent and advanced (for its time) SWift system, which EDS (who took it over) failed to modernise or support. Instead EDS implemented their licence of the Surnise Eclypsis EPR, and seem to have done a pretty good job too. One can wonder why EDS seemed to have no plans to roll that out across the SW, but at least Southmead make a success of it.

Then Southmead became NBT with Frenchay and Eclypsis is replaced, who knows why, possibly because the system was not being exploited elsewhere. What ever, NBT then seems to have become very cosy with CfH and pushed itself as a front runner, OK a little delayed but still a pathfinder, as is their reputation.

But maybe having stuck their neck out as a CfH friendly Trust there was no way back once NPfIT faultered. We can all be hostages to history, and what seemed a good thing then is maybe less attractive now. I suspect they are stuck with the contractual and specification limitations of CfC's contracts. But with all their experience of system change, they will figure this one out too.

But one has got to wonder why, with all the operational closeness of Bristol (and Weston), Bristol does't have some form of shared IT service. Don't they like each other?


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Shared IT Service?

Daniel Defoe 147 weeks ago

Don't NBT and Bristol like each other? What a suggesstion! I'm sure they have the same brotherly feelings towards each other as the fans of The Pirates and The Robins (Bristol's two soccer teams for those looking puzzled).

The question of sharing IT is a reasonable one, but why just IT? What about other support and enabling services such as Payroll, Finance, HR; in fact what about sharing other services such as Pathology and Radiology? And perhaps other services might be shared too like, er, the nursing workforce, the doctors, etc. And perhaps what about sharing Trust Boards? In fact, come to think of it, why not go the whole hog? After all, NBT was formed out of two organisations, Southmead and Frenchay, so there's some experience in sharing there.

I do find it strange that some people seem to think that shared services for IT is a "good idea" even in cases where the organisations who have to share it are permitted entirely different corporate strategies and, as a consequnce, entirely different IT strategies. The two Bristol Trusts currently have entirely different corporate strategies - no reason at all why they shouldn't - and as a consequnce different IT strategies, so sharing IT doesn't make any sense.

This has nothing to do with NBT's problems, of course; it's just a comment on the knee-jerk reaction of looking for savings in IT by suggesting IT services be shared.


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Daniel Defoe
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Of course you expect disruption but not like this

spotlight 147 weeks ago

Replacing a PAS at a hospital of any size is complex and it is natural to expect some disruption. However, IMHO, the level of basic problems experienced time and time again at these Cerner sites shows that people are not learning basic lessons.

- You have to test migrated data - there is simply no excuse for moving appointments incorrectly

- Cerner is not intuitive or easy to use and that means that you have to increase your training and as importantly ensure that users understand the system and use it correctly after that training

There has been an unprecedented level of investment in these deployments. It looks like some of that money should be spent on nailing the basics.


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NBT's position

OzLurker 147 weeks ago

Who on here is criticising Mr. Bell or NBT? Certainly not me, I have nothing but sympathy for the NBT IT team, the clinical and admin staff and the patients.

I just wonder how this cobbled together three green field site semi post-NPfIT deal was done and how much freedom the Boards at NBT, Bath and Oxford had to accept or reject Millenium? The history of Cerner in the NHS has been patchy to say the least. IMHO there is reason to think that the interface is non-intuitive and clanky and question whether there may also be issues in the underlying code.

The appearance and architecture of Millenium can hardly be called cutting edge IT in 2012 and it's very expensive.

More importantly where is the compelling peer reviewed evidence that this complex & difficult to use software actually brings the supposed gains of enhanced safety, better data capture & analysis and improved work and cost efficiency where it is deployed?

Without this there should be no more deployments and the prospect of a switch on at Imperial over four physically separate teaching hospital sites should give all involved pause for thought.

It seems to me that where IT teams are in a straight jacket to implement an already written system their real skills are not being properly used. Add to this the limited ability of clinicians to impact on the functionality and appearance of the software and you have been set up for a fall, whether ultimately it is the local Board, the Regional Health Executive or the central Dept. of Health who are really responsible.

Millenium needs a full independent appraisal and as the US Institute of Medicine said in its recent report the vendors have got to be less secretive and more collaborative.

In my opinion Mr. Bacon is correct in his call for a halt and full assessment of the real impact of this system on the English NHS, even though some of us called for the same in 2008.


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I suggest we should be more appreciative and understanding of NBT's position.

John Aird 147 weeks ago

Martin Bell, (Director of IM&T at NBT) is an experienced person leading a capable and experienced team, give the guy (the team) a break. Such implementations are hugely complicated and difficult, even if you wern't working to an NPfIT contract. From what I know of the CM system it is far from a straight swap out, the replacement system will not look like or function like the systems their users have become used to.

The team will be teaching the Trust to work in a substantially different way. Hundreds of people will have to learn new tricks, Thousands (possibly) of clinic lists will need to be audited and transferred. Everything will be subject to data quality checks. Not forgetting the mixed agenda pressures of ther NPfIT contract. With luck they will have had a few trial runs and clean-up sessions, but probably not as many as they would have liked.

The potential for problems is all around, the consequences of faults (who ever is to blame) are substantial and well appreciated by the Trust, who would not have entered ths process lightly or unprepared. It is easy for us to sit on the sideline and offer helpful advice and opinion, but it makes their job all the harder. It takes a courageous person to lead from the front, but you don't make progress unless you do, and that is one of the roles of an IT Director. There may well be problems and lessons, but let us wait to hear from NBT as to what and why. Meanwhile I wish Mr.Bell and his team all the best during a difficult time


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And it's good luck from me too.

Daniel Defoe 147 weeks ago

Absolutely right John; and we all hope and wish that Mr Bell and his team get through this "difficult time" (not to mention the patients whose care, of course, hasn't been compromised in any way) very soon. The problem is, of course, that bad news stories are generate more readership and comment than good news ones - I think. The problem is that unless the North Bristol implementation goes even more awry, we'll never hear another thing about it. Either there's some resounding successes out there which people are keeping mighty quiet about, or all that's been achieved after a great deal of money being spent is little more than a replacement of the applications and functionality which Trusts had before, but without achievement of any of the significant benefits which the business cases, nationally and locally predicated. In other words, perhaps we should be questioning whether all that we're doing with the National Programme systems, and all their apparent contractual and other constraints, is replacing one perfectly serviceable and inexpensive PAS Plus with one which is less serviceable and more expensive. Either that, or trusts undertaking the change haven't properly scoped what is to be achieved, then programme-managing it so that it's successful. Once again, how is CM at Weston-Super-Mare going?


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Deafening silence

layton 147 weeks ago

Daniel I have lost count of the number of times you have asked that question (re Weston Super Mare). And never an answer. If it was going well I would have expected shouting from the rooftops from the Trust, or CfH, or Cerner or someone. The deafening silence suggests that all concerned have been warned off commenting. Now why should that be?


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Just the facts Ma'am

StormOne 147 weeks ago

From what I have seen, it is NORMAL for a Trust to suspend/relax parking restrictions when a Trust changes PAS. It is NORMAL for staff to take longer to use a new system. They have only seen it in a training room for a few hours before they are faced with the new system in a busy Outpatient Clinic. So it will take them longer to begin with.

I think we need to look beyond the local rags and actually have an independent assessment of the last two Millennium go-lives. Although from all the who-ha about perceived chaos, it seems to be very different in both these go-lives. One delayed and had minor problems (less noise coming from it) and one did not delay (quite a bit of noise). My suspicion is that there will be quite a few good lessons to learn from one and a few bad from the other. Did one know why it was good to delay and the other not? Maybe it is a good idea to delay.

But why bother finding out. No Trust ever listens to lessons learned. We are different they will tell you. We know our Trust. We won't have the same problems.

For all the sense the Rt Hon Richard Bacon has said over the years: Please can we please have the facts? Just the facts. And not the sanitised facts.


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This is a global reality

Neelam Dugar 148 weeks ago

http://www.seedie.org/

Will make you laugh. But it is really serious. NHS needs to move from expensive monolithic EPR systems to connected departmental systems using global EPR standard--XDS. This will lead to a multi-vendor competitive enviornment which is key to innovation.

2 weeks ago we went live with Ordercomms in a large DGH--which completely integrates with PAS & RIS & PACS(4 separate vendors). Big success. Not a single complaint. Paperless workflow from requesting to report. Very good vendor co-operation.

There is NO NEED for single monolithic EPRs.


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EPR is a necessity

NHSCIO 148 weeks ago

Sorry Neelam, I don't agree. Clinicians tire quickly of multiple systems , all the bag of bits approach does is ensure you never can get totally rid of paper. Sure you can replace transactional processes such as order comms which is enough for some, but ultimately replacing the paper clinical documentation is why you need an epr to transform the Trust.

Also where did ehi dig up that photo of Richard Bacon? Last time I saw him he had significantly less hair and was significantly more "husky".


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It's an EPR!!!

Daniel Defoe 148 weeks ago

Just to remind people, Cerner Millennium isn't "PAS" (as a couple of posters below seem to think). It is (or at least it's supposed to be) a full "Electronic Patient Record" system. And actually, from what I know of it, it doesn't even contain PAS functionality in the traditional sense - which is why some implementations of EPRs keep their existing PAS in place until such time as full EPR functionality roll-out replaces it. Clearly, Oxford and North Bristol adopted the high-risk strategy of not keeping their PASs in place, and so switching off or falling back won't be an option for them. Of course, the biggest error appears to have been in testing before go-live, and perhaps whoever signed off the required Test Acceptance Certificates on behalf of the Trusts ought to be considering their positions. And I still can't understand why Weston Area Health trust isn't crowing from the rooftops about how good Cerner Millennium is; after all they've had years of live running, and presumably they're on their second dentition by now.


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Daniel Defoe
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PAS or EPR?

OzLurker 148 weeks ago

Daniel for a high level poster on here you're missing something about Millenium;

When you buy in you supposedly buy into a complete system requiring no other provider but what you get first is a difficult to use and slow PAS. The clinical functionality is due to come along later be it PowerChart or OrderComms and eventually(?) the full EPR by completion of a process taking 3-5 years.

In Taunton at switch on ALL we got was a window based and click heavy PAS. In the run up to the implementation we were told our old PAS and discharge letter writing system (MDI) would have to be switched off at go-live. This I understand is usual Cerner strategy. [NB We had all the slow motion and appointing problems that N.Bristol encountered 4 years later - so if unexpected by their implementation team their toil was no surprise to me.]

The loss of our MDI system which was collecting colposcopy data required us to buy a new stand alone system as Cerner had no UK Colp module and their maternity system was so immature that we had to buy Huntley's Eclipse as a stand alone too. Getting these reasonably good systems to interface with Cerner's PAS was very difficult and the DoH had stated only one way data migration, PAS to peripheral systems was allowed.

I do not know of any UK Cerner implementation that truly provides a complete electronic patient record with a level of functionality that allows a paperless hospital. (Can anyone update us and categorically say I am wrong about this?)

This vision was total interoperability, no paper, ease of use and fantastic primary to secondary to tertiary care communication and back again. Time to be honest, some are making progress but no where in England has this vision been delivered indeed I doubt any secondary care provider can claim to have a full EPR, and certainly not those using Millenium.


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MDI? Ah yes, I remember it well...

Daniel Defoe 147 weeks ago

Oz; ah, how you misjudge me. Err... not sure whether I should confess it, but I was actually one of those heavily involved in the specification and subsequent development of MDIs - and not just for colposcopy - even long before HP was EDS was Swift, or PAS became IHS etc. Ah, those were the days. While, in Taunton, switching off your old PAS and MDIs might have been something you were "told" had to happen, it smacks to me of a lack of proper planning. In recent procurements I've been involved with, Tenderers (including Cerner) have been"told" very firmly (as part of the OBS) that the client Trust will be keeping its existing PAS (and all the surrounding functionality necessary to "run the business" until that functionality is gradually replaced over an anticipated migration to/roll-out of EPR over, as you say, perhaps 3-5 years in accordance with an outline migration/implementation plan required as part of the Tender submission. That way, the Trust's income, and operational stability remains secure. And in these cases, only one potential Tenderer (who currently doesn't have an implementation of any sort in the UK) has declined.

In short, "...when you buy in you supposedly buy into a complete system requiring no other provider..." is not true. What you buy into is up to the client, not the contractor, and should have been expressed very clearly not only in the OBS, but in the Service Agreement/Contract. I hate to say it, but it does seem that both North Bristol and Oxford have allowed a Supplier/Contractor to decide what will be provided rather than determining it for themselves.


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Turn it off? I don't think so!

HealthITSlave 148 weeks ago

Richard Bacon, whilst well meaning, clearly doesnt have experience in this area. Following progess is not like being involved and doesnt bring insight or skills. I follow F1 but I doubt they will want my advice. Anyone in the game will know that you cannot turn off a PAS 4/5 weeks in without very serious implications.


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Experience!

OzLurker 148 weeks ago

How many English Cerner implementations have resulted in Hospital administrative or financial meltdowns and at what cost to the public purse?

Three, Four, Five or Six at 100, 200 or 300 million sterling?

And under the UPMC/Cerner contracts demanding staff silence on system preformance how many 'teething problems' have we never been told about?

I think Mr. Bacon has a better feel for this issue than some on here.


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Experience?

John Harry 148 weeks ago

How many implementations of a massive software change has Mr. Bacon managed? I thought so. Enough said.


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