- Trust: North Bristol NHS Trust
North Bristol NHS Trust has gone back to paper to process some outpatient appointments as it works to fix issues with its implementation of Cerner Millennium.
An update from the trust says it is processing 60% of outpatient activity via its new electronic patient record system and hopes to have all outpatient clinics working with it successfully by early February.
“All other outpatient appointments are being managed via other systems and paper processes,” it says.
EHealth Insider reported earlier this month that the trust was having some problems with its go-live of Cerner Millennium.
These left some patients being booked into non-existent clinic appointments or not being told about scheduled operations.
The trust says the problems in outpatients were caused by incorrectly configured clinic lists, which led to issues with the interaction between Millennium and the Choose and Book electronic booking system.
These led to patients receiving the wrong appointment dates, no confirmation of appointment, or letters being sent out in error.
The trust’s statement says it has engineers and technicians working closely with Cerner and BT on ”either re-building the clinics’ system or on the floor in clinics correcting problems as they happen."
North Bristol has been contacting patients by phone or letter to advise them of their current appointment slot and has prioritised urgent referrals, including cancer two week waits, to make sure they are not affected.
The trust has also been contacting GPs to reassure them that referred patients are in the appointment system.
In a letter to local GPs, it says they can ring the appointments helpline with any outstanding queries or use a new dedicated fax line to send through a duplicate referral. The helpline service will run until the end of February.
The update says the Emergency Department and two Minor Injuries Units are now using Cerner Millennium effectively, along with 65 wards and the maternity department at Southmead Hospital.
“Some theatres had experienced problems relating to the transfer of data from the old system to the new, causing delays with rescheduling some operations,” it says.
However, these problems have been rectified and all theatres are now using the new EPR.
Information provided by North Bristol explains that the implementation involved the retraining of 6,500 staff and the transition was expected to take place over eight weeks.
“Our priority is always clinical safety and there is no indication that this has in any way been compromised during this implementation.”
The statement says it has “additional safeguarding processes” in place to minimise further disruption to out-patient appointments and apologises for the disruption and frustration caused for patients.
The problems at North Bristol and problems with appointments and long waits at Oxford University Hospitals NHS Trust, led MP Richard Bacon to call for a halt to deployments of Cerner Millennium last week.
© 2012 EHealth Media.
Data migration problemsLaburn 142 weeks ago
In response to OzLurkers comment:
"2. All NHS IT teams in every Trust are unable to respond to the challenges faced by such implementations/data migrations.
This could be due to a. lack of personnel (denied), lack of funds (we are told not so), lack of skills (very unlikely to all a problem at everyone of the Trusts involved!)"
The challenges faced by Trusts during these highly complex project almost always overlook data migration when planning the project. Data migration is such a key area that has a huge impact on a risk free go live, and is usually not funded appropriately, is always an afterthought, and whenever the project slips is always compressed to maintain other project milestones. IMO (and from bitter experience over many years working on these projects), it is unusual and highly unlikely that Trusts have any understanding of the kinds of data quality issues that they are likely to uncover until way down the line, and then don't have the resources to resolve in a timely manner during the project.
There is also little recognition or understanding of the transitions that the data will have to make to be moved from one technical architecture to something ofton completely different.
Start early, identify the data quality issues, have focussed, experienced resources, and don't blame the supplier of the new system!
Is there a solution?Daniel Defoe 142 weeks ago
But if these problems are the same ones encountered at e.g., Barts, Royal Free, MK etc., the question should be "Why hasn't Cerner solved them so as to ensure they never happen again?". It could be, perhaps, that there isn't a solution. Or it could be, perhaps, that in each of these cases, the Trust concerned just wasn't up to implementing properly...
Solution? - we need to understand the problem firstOzLurker 142 weeks ago
You raise an important point in the face of repeated difficulties. Unfortunately we don't know the answer so it is likely the forthcoming implementations at Royal Berks and Imperial will face the same difficulties at switch on.
The possible answers to the conundrum are;
1. Big Health IT is immature and all such large implementations are doomed to major problems at switch on (possibly true but politically unpalatable).
2. All NHS IT teams in every Trust are unable to respond to the challenges faced by such implementations/data migrations.
This could be due to a. lack of personnel (denied), lack of funds (we are told not so), lack of skills (very unlikely to all a problem at everyone of the Trusts involved!)
3. The software is not fit for purpose. For Cerner this could be due to a. it being a US system which is difficult to migrate to NHS culture and practices (possible), b. a poor and difficult to use interface which is complex to use and/or train to use (reported by many but still anecdotal), c. a major architectural flaws in the software design or code (only independent analysis I know of is from Uni of Sydney about Cerner's Emergency Dept. software FirstNet, this is an alarming report and may have wider implications)
For me we really lack evidence to answer these questions unequivocally for Millennium and other apparently failing systems in the English NHS.
My conclusion would be that Mr. Bacon is correct in calling for a halt to implementations and spending until we have better evidence. A general high-level direction and belief that big Health IT in secondary care will improve workflows, save money and will make patient care safer simply is not good enough. The experience so far on the shop floor does not support any of the above and the lack of openness of the software vendors and the inability of clinical and admin staff to comment on the impact of these interventions is hampering our ability and that of the NHS to understand what is really going on.
When I introduced a new keyhole procedure to my Trust it had to go through a business case and then I had to audit the outcomes and report back to my Department about the outcomes, adverse events and risks. This process should be ongoing for all Health IT switch ons, particularly those impacting directly on patient care like ordercomms and prescribing packages, but it is needed for admin too - buying systems that result in each task thing longer or requiring more staff to cope is not what was envisaged.
Repeat OffendingOzLurker 142 weeks ago
My Father used to say to me when you have a bad experience once you can look to others for the cause, when it happens again you need to reflect a bit and if it happens a third time you need to start looking at yourself...
Taunton/Cerner, Royal Free/Cerner, St. George's/Cerner, Wirral/Cerner, North Bristol/Cerner .....
Ummm is there a connection here?
NB When is the GMC's new directive to Doctors urging whistle-blowing if patient care/safety is threatened going to yield information and disclosure about poorly performing Healthcare IT?
How about "North Bristol reverts to paper for up to 40% of outpatients"spotlight 142 weeks ago
It is truly shocking. Imagine the impact on 18 week RTT and the trust's ability to manage patient care. Imagine what it is like for patients and staff.
Many Cerner deployments (Barts, Royal Free, Milton Keynes etc etc) have had these types of problems. The problems and causes are well documented. Frankly I am surprised that the trust decided to go live without these types of issues being cleared up.