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Cerner challenges Cambridge EPR decision

5 July 2012   Jon Hoeksma

Cambridge's eHospital logo

Cambridge University Hospitals NHS Foundation Trust has been challenged by clinical IT vendor Cerner over its recent eHospital electronic patient record procurement, in which Cerner was beaten by US arch rival Epic.

The firm accuses the high-profile trust of failing to conduct a fair and transparent tender process and of picking a winner in advance - which it then rigged the tender process to deliver - ignoring considerations of price and proven product.

Cerner calls for the trust to re-tender, a suggestion that Cambridge has given short-shrift.

A trust spokesman said: “The trust has run an open and fair OJEU competition in line with public procurement processes. The trust is continuing to proceed with the procurement process for eHospital.”

In April, eHealth Insider reported that Epic had won the Cambridge University Hospitals and Papworth Hospital NHS Foundation Trust joint electronic patient record procurement, with contracts expected to be signed by the end of June.

The trusts selected Epic, ahead of a shortlist of Cerner and Allscripts, in one of the most important NHS IT procurements in recent years. The outcome means Cambridge will become Epic’s first UK reference site.

Sources close to the procurement insist that the highly unusual move by Cerner “is not about sour grapes” but that it was triggered when the company received extremely odd supplier feedback on the procurement “that made clear price wasn’t a primary factor considered.”

The allegations of a rigged procurement are set out in a letter to the trust’s interim chief executive, Dr Karen Castille, from Cerner’s vice president and managing director Alan Fowles.

This says the company “has never considered contesting” a previous decision, because “tender processes have been conducted in a fair and transparent manner” but “sadly, the same cannot be said for the tender you have overseen.”

The letter accuses the trusts of not looking at price as part of the evaluation criteria; of favourably scoring Epic’s unproven patient administration system; and of running the short-listing process twice after the first round “failed to give you a shortlist that included Epic.”

The central allegation made is that the trust had made up its mind that it wanted Epic and changed the procurement process to get the desired result, breaking a series of procurement rules.

Sources suggest that the Epic bid was in the region of £30m, up to 50% more expensive than other shortlisted suppliers.

“Having reviewed feedback from Cambridge University Hospitals’ e-hospital tender, we had significant concerns about how the procurement was conducted,” the letter says.

“We find it difficult not to conclude that you had made a pre-determined decision to award the tender to Epic some time before you designed the procurement process; this, in turn, put every other vendor that chose to enter the process to considerable effort and expense with no realistic possibility of winning the tender.

“We believe that the only fair way to resolve this matter is to publically re-tender and we therefore urge you to reconsider your decision.”

Cerner’s European boss then goes on to remind the trust that it is a public body and has a duty to ensure tax-payers money is spent “wisely, fairly and in a transparent manner.”

The letter, which has also been sent to the trust’s chairman, Dame Mary Archer, also requests that Cambridge publishes “full details” of its internal documentation in relation to the tender.

The Cerner letter also alleges that earlier, unseen correspondence with the trust’s lawyers had “already acknowledged that aspects of your procurement process were highly inappropriate.”

EHI understands that Cerner’s lawyers have been in contact with the trust but the company was unwilling to confirm whether it would mount a full legal challenge should the trusts decline to respond as desired.

Read EHI editor Jon Hoeksma's analysis of Cerner's decision and what it could mean for the NHS IT market in Insight.


Related Articles:

9 News: Epic win at Cambridge | 27 April 2012
4 Insight: Cerner says NHS on digital 'tipping point' | 24 April 2012
10 News: Cambridge produces all US shortlist | 2 December 2011
16 News: Cambridge receives 50 bids for EPR | 3 October 2011
News: Cambridge starts hunt for a new EPR | 18 October 2010
Last updated: 9 July 2012 15:22

© 2012 EHealth Media.


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Joe McDonald 127 weeks ago

Interestingly, when I recently wrote a column on this site suggesting that suppliers volunteer to be assessed by my nascent clinical software comparison website I was contacted by a few suppliers to discuss the possibility, Cerner were not among them.


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Predisposition to procure ...

DayJarView 127 weeks ago

In my 40-something years in the health sector I'm not aware of a single tender that has been issued without the purchaser having a preference that has been reflected in aspects of the specification.

The reason companies have sales people is to gain that advantage. The chances of winning a tender published in OJEC if you've not helped write the call are so close to zero as to make it barely worth jumping through the hoops - whatever the field (i.e. the NHS is not alone here).

We used to call it "Making up the numbers" and the only reason for responding was to put in a bid so low as to pressure the profit margin of the preferred supplier. Cynical, but commercial reality.


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Agree

CanUseeTheLight 127 weeks ago

Been there seen it and very recently bought the tee shirt to make up the numbers.

very sorry state of affairs but that is hte nature of the procurment process.


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Public Procurement?

John Harry 128 weeks ago

If price is not a factor what is the purpose of a public procurement? A trust can always ask a supplier to demonstrate its products under whtaever circumstances a trust desires.


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Procurement Principles

Charles Gallagher 128 weeks ago

A useful one pager describing what a trust should be aiming to achieve through a procurement exercise. Indeed it does mention that they have to " Be responsible stewards of public funds"

http://www.cips.org/Documents/About%20CIPS/International%20Development/Values%20and%20Guiding%20Principles%20of%20Public%20Procurement.pdf


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hmmm

CanUseeTheLight 127 weeks ago

And by what arcane process are these stewards deemed responsible?


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Not a legal challenge

Jon Hoeksma 128 weeks ago

Its very interesting that the letter extensively quoted above was sent on 29th June - the last day on which a legal challenge could have been mounted under standard procurement regulations.

The letter sent is not a formal legal challenge - though EHI understands that there was plenty of preceding correspondance from 'm'learned friends' to the trust in advance of this letter.

Curiouse and curiouser...


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Pyrrhic

just_instantiate 128 weeks ago

Just a thought, but if the EPR big boys are going start challenging every decision that goes against them, they risk undermining the single-vendor EPR concept, in commercial even if not technology terms. Many trusts must be revisiting their strategic direction of travel. One good thing that might come from this is that the healthcare industry might start looking beyond the false dichotomy of best-of-breed vs. single-EPR, and start thinking enterprise solutions and enterprise architecture.


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hmmmm

CanUseeTheLight 127 weeks ago

yet more dreaming I fear. The procumrne process as is is designd to maintain the status Quo


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Partial disagreement

just_instantiate 127 weeks ago

The procurement rules need not set barriers that imagination and a proper architectural approach can't overcome. Unfortunately, they are what dwell in Dreamland.


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The need for Transparancy

nike 128 weeks ago

Cerner have obviously given this challenge a lot of thought and legal review before sending this letter to the Trusts and feel that the potential outcome outweighs the possible representational damage that a challenge like this may incur.

The Trust set out a set of criteria in their procurement, with weighted scoring and it is against this that the suppliers had to respond. At each stage the trust should have assessed the relative strengths of each bid against their criteria and shortlisted/selected based on the outcome. Not having seen the procurement ITT documents I dont know what was asked for or what the assessment criteria were but I would expect price to be one of those criteria. Perhaps the Trust used value for money as one of their selection criteria and not total cost in their consideration and can therefore justify the selection of a system that is significantly more expensive (if the sources in the article have it right)

Given Epics lack of UK experience and availability of a product it does make it a big call for the trusts to have gone with them and I would expect this is due in the main to Clinical pressure. All the clinicians in the room said the must have it in the demo I saw and this is without any consideration for how it handles such things and administration, scheduling and coding which are very dull and boring (although they have the advantage of keeping the hospital running and financed!)

So we don't know it the Epic selection was based on a fair and open selection process based on the defined criteria or if the Clinicians have said they want Epic and the trust team have worked hard to give them what they asked for. Cerner are obviously very clear that somethig here smells fishy and are prepared to take the Trust to task over it.

For all of you who have posted about the National Programme - I agree this exposed the Cerner Product of 2006 as something that promised a lot and worked well in the US but was untested in the UK and has taken 6 years to get right....I wonder if Epics promises and more real?


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Cheap is cheap

itmanager 128 weeks ago

What ever the 'reasoning' behind this decision, it's clear from the problems with implementations of Cerner, that a cheap system is just that cheap system. If you want a good product you have to pay for it; or build it yourself.

Procurement procedures in the public sector sometimes appear to be too fair to suppliers, and not on the people that have to live with it. You really want quality over price - and the NHS needs to be brave and make that decision.

On the point made by 'personal opinion' - a NHS agency perhaps is the way to go. Wouldn't it make more sense for an NHS IT Organisation - one that can work for the NHS across the country, write systems from scratch. The amount of money spent on procurement and implementations of major systems across the UK in the NHS - must be massive, certainly more then setting up an Organisation within the NHS for writing IT systems from scratch.

Get a load of developers, some project managers, and some implementation experts to manage the whole thing centrally - I'm all for local control, but when it comes to computer systems - it's better to invest centrally; and work with all NHS organisations.


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I beg to differ in the biggest way possible

CanUseeTheLight 127 weeks ago

The price one pays for an information system in no way shape or form has any baring on said systems capabilities. It is simply a reflection of how much the seller wants / needs to recoup on its development investment and maintain its ongoing expenditure. To think otherwise is at best naïve. I can sell an information system for 1 tenth of our competitors, it is functionally more rich and built using a very smart technology platform. I can do this with a handful of UK based developers in a company that has low overheads. This is what determines the price of a product not its content. At any given point in time you get all our kit for £X next year you will get all our kit as at that date plus an indexed linked price increase. I would not even consider charging £2X because I though I could get away with it. All you have to do is look at the variation in price for any of the systems supplied by LSP’s as part of NPfIT interim or otherwise and you will not fail to see it happening.

I find your comments very unsettling given you may be an IT manger. Your last paragraph being the most unsettling of all as it shows a fundamental lack of understanding of the entire development process and the rate at which requirements change within the NHS. This is the reason we are all now in the mess we are in. Big companies getting a bunch of (hundreds in some cases) developers and related professionals and a large dose of arrogance in thinking that a centrally mandated one size fits all approach will be easy to deliver and tick all the boxes, please, get real look at the mess iSoft made of Lorenzo look at the mess the DOH made of NPfIT and you think the same crew will succeed.

I despair.


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Is Cerner a "cheap" system now?

It is I, LeClerc 128 weeks ago

While i agree that paying a low price usually limits your delivery expectations, paying over the odds does not always mean you get proportionally more.

Is Cerner now a cheap system, i know many who would disagree. Is there some evidence that Epic delivers a better return on investment?


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tactics?

just_instantiate 128 weeks ago

I notice that Cerner has not actually mounted a full legal challenge, unless the trust "decline(s) to respond as desired". But what response could Cerner desire other than a re-opening (re-starting?) the entire procurement. Presumably the trust will rebuff these opening shots with some statement to the effect that that it robustly defends the fairness of its process. Cerner could hardly back down from that (one presumes that it factored in that Dr Helen Castille's letter would become public.)

I wonder if a legal challenge was on Cambridge's risk register. If not it will certainly be on those of future EPR procurements. That includes the London consortium, which may be the real target of Cerner's action.


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The tail wagging the dog...

The Luddite Insider 128 weeks ago

Isn't it the turn of the NHS to sue the CfH contractors such as BT/Cerner & CSC/iSoft for delayed-delivery of EPR systems?

If the LSPs and its sub-contractors had delivered on PAS/EPR in time, there would be no need for Cambridge or Oxford to go out of program to open procurement of new PAS / EPR systems.


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Err what did we tell them would happen

CanUseeTheLight 127 weeks ago

look back 10 years at all teh nay sayers who predicted exactly this situation.


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Reliability

Inventivestep 128 weeks ago

How much did NatWest spend? How soon before the first EPR system becomes unavailable for two weeks?

How much did Sony spend? How soon before the EPR becomes available to the outside world?


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thats already happeing

CanUseeTheLight 127 weeks ago

There are many such examples of just that but gagging orders and instant career destruction prevents NHS staff from blowing on that particular instrument.


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