BT the local service provider for London is to develop its own version of Cerner Millennium for London, separate to the version of the system being installed and developed for use in NHS trusts across the South of England.
BT's decision to de-couple London from the South appears to have been prompted by well documented problems at some of the five initial NHS sites to take Millennium in the South of England delivered by LSP Fujitsu.
The Millennium software has been chosen by Fujitsu in the South and BT in London as their means of delivering integrated care records as part of the £12.4bn NHS IT programme.
EHI understands the London LSP will not be re-writing Cerner's software focusing instead on configuration and testing prior to deployment.
According to a Kingston Hospital NHS Trust board paper seen by EHI: "Problems at early sites included issues with meeting statutory reporting requirements, data quality and migration including migrating future appointment slots leading to wait targets being missed , and the system becoming unavailable."
The board paper makes clear that the decision to follow a separate development route in London stems from the problems in the Southern cluster: "Problems encountered in the South prompted BT to propose to London that development of the Cerner Millennium product for deployment in London should de de-coupled from that being deployed in the South. This BT proposal to develop and deploy a London-specific variant of Cerner Millennium (now known as LC1, LC2 etc.) has since been agreed."
The LSP says that the move is prompted principally by the special requirements of the many teaching trusts in London and need to be in control of its own destiny and "not dependent on others".
Problems reported at sites including Nuffield Orthopaedic Centre and Milton Keynes have included patient records becoming unavailable to clinicians, data migration resulting in clinic appointments being lost, inability to meet statutory reporting requirements and 'domain issues' – in which a number of trusts share a single installation of the Millennium system.
Other difficulties have included staff being trained on a different version of the system to the one they actually receive. Earlier this month 79 staff at Milton Keynes signed a letter stating that they did not view the Millennium system installed as yet 'fit for purpose' and recommending that no other trust take it until problems are resolved.
Sources close to Fujitsu and Cerner have however indicated that the quality of data and how trusts prepared for implementation has been an important variable in the success of go-lives so far.
BT confirmed to EHI that it was now developing a London version of Millennium: "It would not be appropriate for BT to comment on implementations in a region other than London. We [BT] can confirm however that the version of Cerner which we will soon be deploying in London has, in a number of ways, a different specification from the version being delivered in the South."
While Fujitsu is using Cerner Millennium as a single integrated solution for NHS Trusts BT has adopted what it has previously termed a 'de-risked', 'best of breed' approach in London in which Millennium will be used for acute trusts, while CSE Servelec will supply its RIO software for community and mental health trusts and In Practice Systems will supply software for primary care.
BT confirmed it will be using a range of products in London: "This specification was agreed between BT and NHS London to meet the special and specific requirements of our London trust community and reflects the fact that, in London, we support many more major teaching hospitals and use different products for non-acute care settings.
"Additionally we have built on lessons learned from our own work in London and the experience of our colleagues in other regions."
The move by BT appears to end the vision of a single standard electronic patient records system being used in NHS trusts across London and the South of England, instead different versions of the US Cerner Millennium system offering different features will be pursued for the foreseeable future.
BT says that the 'London Cluster' version of Millennium will include additional functionality and features, that were in the scope of the system originally deployed at Newham and Homerton but are "not within the Southern configuration". The company did not detail what these features were.
Ironically, what now becomes the Southern version of Millennium was based on a version of the software first deployed at Homerton and Newham in London ahead of the NHS IT Programme. Fujitsu, with the approval of Connecting for Health, bought this software as installed at Homerton and Newham but has since required significant changes to be made.
This means there will be at least three configurations of Millennium in the NHS, with any changes required by Wirrall Hospitals – which has separately purchased Millennium through Fujitsu - likely to create a fourth.
BT's decision to de-couple its London development of Millennium from that occurring in the South is in some ways a mirror image of Fujitsu's 2005 decision to de-couple itself from the BT-led IDX CareCast 'common solution' for London and the South, which by summer 2005 led to it replacing IDX with Cerner. BT subsequently itself replaced IDX with Cerner a year later.
To date BT has delivered a new patient administration system to just one NHS trust in London, Queen Mary Sidcup. The IDX CareCcast system provided to the trust is now scheduled to be replaced with the Cerner Millennium PAS.
The Kingston Hospital paper states that the BT's decision to pursue its own development track will initially lead to additional delays in the London deployment schedule "of around 2 months". BT says that the move will not result in further delays.
The first three sites pencilled in to get the London configuration of Millennium are believed to be Queen Mary's Sidcup, Barnet and Chase Farm and Bart's and the London, with pre-deployment testing now underway. The first implementation is scheduled to occur by the summer.
US-based Cerner, which is a leading international health software provider, said in its quarterly results last week that that it has to date "turned on more than 6,400 Cerner Millennium solutions at more than 1,100 client facilities worldwide".
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