- Trust: Weston Area Health NHS Trust
A series of 2011 benefits analysis reports for Cerner Millennium implementations at Southern trusts have been submitted to the Department of Health.
The reports will feed into an updated statement of benefits for the National Programme for IT in the NHS, and the £2.7 billion that it has spent on care records systems so far.
The DH was supposed to submit the update to the Commons’ public accounts committee by September last year.
Its failure to do so was criticised by the PAC, when it held hearings on the National Audit Office's third report on the programme last summer.
EHealth Insider has a Benefits Position report, dated June 2011, produced by a benefits realisation sub-group of the CRS Live Sites Executive – a voluntary group with members drawn from each of the Southern trusts live with Millennium.
The report says the sub-group was created to “maximise the benefits to be gained from the CRS Upgrade (LC1 enhanced) for the seven live sites in the Southern programme” – and implies that some trusts had seen few, if any, benefits by then.
“With competing priorities, and where reduced levels of transformation/business change have been applied or are scarce, there is a marked reduction in benefit realisation,” it says. “The group are sharing optimisation processes and additional benefit realisation plans.”
The report says the group was due to deliver a unified submission to the DH outlining the benefits position for 2011.
EHI understands individual trusts have been sending reports to the DH since late last year, but despite submitting many requests to the DH, Southern Programme for IT, and individual trusts, EHI has not been given access to them.
The first eight trusts in the South to go-live with Cerner Millennium had the system deployed by Fujitsu, when it was local service provider for the region.
After Fujitsu exited the programme, BT was awarded a contract to upgrade the existing Millennium installations - which were reduced from eight to seven when one trust switched off the system.
The June 2011 report says Cerner R0 had “limited functionality” and benefits realisation was “scanty."
The BT upgrade was designed to deliver a “new or enhanced suite of benefits” to each organisation. The CRS Live Sites Executive is monitoring whether these have been achieved.
Each trust has identified its top five benefits, creating a register of 35 benefits. The most common benefits being monitored are clustered into groups.
Those relating to connection to the Patient Demographic Service include: improved recording and accuracy of demographic details; results requesting, reporting and viewing in one system; reducing delays in patient care; and reduction in duplicate requests for tests.
Those related to efficiency include: data automatically integrated into the discharge summary; maternity and emergency department in one integrated system; and increased theatre utilisation.
With regards to quality and safety, the potential benefits are: a reduction in clinical incidents; and improved governance and consistency of care, while better payment coding allows for improved recovery of costs.
“As staff, roles and utilisation become more dynamic a second wave of benefits are being considered and unexpected benefits are being reported,” the report says.
However, reports that EHI has been able to obtain for some trusts suggest these are not being closely quantified, or expressed in financial terms.
Trusts that agreed to provide interviews and statements to EHI also provided information suggesting that benefits have been slow to be realised; in part because they have only recently started to deploy more clinical functionality.
Buckinghamshire Healthcare, Surrey and Sussex Healthcare, and Weston Area Health NHS Trusts all said they now had a stable platform, on which they are developing additional functionality.
However, a report to the board of Winchester and Eastleigh NHS Trust dating from last June indicated that while it had identified and realised some benefits, it was finding it hard to realise others where key functionality had not been deployed and “core functionality” was “underperforming.”
EHealth Insider has contacted all of the Southern trusts that went live with Cerner Millennium in 2006 and 2007 to ask about the benefits they have realised. There is a fuller account of their responses in the Insight section.
EHI will be publishing more stories on Millennium in the South. anybody with information can contact reporter Rebecca Todd in confidence.
© 2012 EHealth Media.
DisadvantagesDANCECLOTHEARS 108 weeks ago
Is anyone measuring the disadvantages? Such as increased need for training, staff struggling with a clunky system? And I have heard that the link to PDS means increasing numbers of duplicates and incorrect records are being created on the Spine - potentially a huge problem if the Spine can no longer be trusted.
Database designPeteMarsh 108 weeks ago
I think you will find that the details referred to are Next of Kin information, as like most modern dbase designs, a person record is collected, then a relationship of that person (patient, next of kin, staff member etc) is established and linked to the patient record. Sensible design for person based records and important in establishing sibling relationships etc. I understand Wirral Millenium does send a real time discharge summary from A/E (and inpatient discharge) along with emails to Community Matrons on A/E admissions of patients of Interest, typically COPD, Heart failure, etc.
View from the groundspotlight 108 weeks ago
I took a relative into outpatients at one of the 7 sites recently and despite having been deployed for a long time the staff seemed to be struggling with simple outpatient bookings. I asked whether they liked the system and the rsponse was most unNHS-like. Perhaps as part of the benefits study it would be worth interviewing randomly selected staff on the front line and asking them what they think. I am sure this would never happen, but it would be a pity if a glowing and very helpful benefits report was produced which justified the deployment of these expensive systems and they missed key information because they accidently forgot to canvas the users for their views.
Another view from the groundLyn from eHealth Insider 108 weeks ago
On that basis, I might as well add my own, fairly recent Cerner Millennium experience.
I ended up in the A&E of one of the seven sites, where I was duly clerked into the system. When I was seen by a nurse practitioner, however, she filled in an A4 printed paper form, before leaving me with antibiotics. When a GP came along to confirm the diagnosis and prescription, he turned over the form and scribbled in long-hand on the back of it.
No idea what happened to the paper. And needless to say my GP never received any kind of letter from A&E saying they had seen me...
Hard to say what benefits, if any, the trust had got from the IT bit of all this. Still, the staff also clerked my partner, who was only there to hold my hand, so the obviously like having details on the computer...
re: another view from the ground: is this akin to fraud?Mary Hawking 108 weeks ago
My practice - like most, I suspect - is being asked to validate all acute care attendancies so that the PCO can challenge inaccuracies.
We've had a couple of cases where the A&E report says "registered i error" (one of these was charged twice) or either "patient walked out" or no entry apart from the registration.
I agree this isn't a Cerner problem - but is it akin to fraud?
Don't raise the how do you count it questionStormOne 108 weeks ago
I don't think there is a single acute trust in the country that does not interpret the rules differently on how to count activity. Just so long as they have them documented.
A and E options
Is it type 1 or 2?
Is it a walk in centre?
Is it an urgent care centre?
Is it a minor injuries unit?
Never mind about when the A and E waiting time clocks start and stop...
I have seen acute hospitals with an A and E that also has all of these,
Medical Admission Unit
Surgical Admission Unit
Short Stay Ward
A and E Ward
Clinical Decision Unit
All ways to cut down on the waiting times.
Looked like itLyn from eHealth Insider 108 weeks ago
Hi Paul. At the risk of derailing the comment thread on Rebecca's excellent story... I couldn't swear to it, but the person who clerked me asked my partner all the same questions and typed in all the answers... indeed, half way through we did point out there was nothing wrong with him!
is that true?Paul Cundy 108 weeks ago
Did they really clerk in your partner as a patient? If so that would appear to be a potentially fraudulent action, their only reason could have been to boost their "seen in a/e" numbers and thus increase payments.