The Rotherham NHS Foundation Trust’s non-executive directors have raised concerns about "technical difficulties" with its Meditech electronic patient record implementation.
The trust deployed Meditech in June this year. Phase one included real time bed management, order communications and results, outpatient letters to GPs and discharge summaries.
Papers from the trust’s board meeting in September said the non-executive directors were worried that "technical problems" were “affecting services and the ongoing support to be provided by Meditech.”
In June, concerns were raised regarding, “financial implications in relation to additional workforce requirements.”
A spokesperson from the trust told eHealth Insider that although many areas of the implementation went well, the trust had experienced some operational issues.
“The trust encountered an electronic patient record operational issue in relation to the Choose and Book system,” a statement said.
“Following EPR go-live, some cancelled slots on the Choose and Book system were reopened and patients were booked into them. As a result, patients attempted to attend these appointments which were not available.”
The trust said it had identified the cause of this error, contacted the affected patients and the issue has been “resolved”. However, due to the problems it faced, the trust had to keep certain staff on longer than planned.
“In respect of additional support that we required in order to overcome this issue, the trusts’ data inputters who had been assigned to the EPR implementation remained on this project,” the spokesperson said.
The Rotherham was one of the first trusts to go outside the National Programme for IT in the NHS for an EPR and is the first NHS trust to purchase the latest Meditech system. The value of the deal has been put at £30m - £40m over ten years.
In August, foundation trust regulator Monitor changed the financial risk rating for The Rotherham from three to two due to “deterioration in the trust’s financial position."
A report presented to the trust board in October by soon-to-be-retired chief executive, Brian James, said “compulsory redundancies are inevitable” as the trust cuts bed numbers and staff to save £50m over four years.
The report blamed the trust’s problems on the “economic downturn” and the ‘Nicholson challenge’ to find £20 billion of efficiency savings across the NHS by 2014-15.
Last week, EHI reported that trade union Unison claimed the trust planned to cut 750 jobs over the next three years. However, the trust has yet to make a formal announcement regarding redundancies.
© 2012 EHealth Media.
US EPR vs Clinical portals and all that jazzbrianlee 72 weeks ago
In response to both James77 and PeteMarsh
No one wants to see Trusts struggle with an implementation, and yes hindsight it 20/20. The evidence is however out there that US EPR systems dont port over easily. Meditech does have a large US & Canada base but mainly in the community (200 bed and below) space and Rotherham is or was circa 3 times that size and a UK based hospital. Even reading articles on US hospitals moving from old 5x to new 6x you have to say the experience has been poor.
In response to Portals rule, and the assertion that there aren%u219t any tangible portal examples. EPR level 3 suggests clinical orders, results reporting and prescribing. Many Trusts have Order communications & Results reporting covered, Sunquest ICE is used widely in Yorkshire and the Humber. Ascribe have a very good e-prescribing system in use in many hospitals. At level 4, hospitals have introduced alerting and knowledge bases to tackle specific clinical needs, a quick trawl of this site gives up many examples. Leeds are doing some great work on clinical portals as are many organisations, West Herts and CareFx from Harris as another.
My point around PAS is that it%u219s a vital component to a Trust getting paid in the first instance but more accurately provides a core Patient Master Index which is the essential building block (Level 1) of an EPR. With Rotherham and Meditech this appears to be regressive, by adopting a big-bang US EPR they have lost key and core functionality present in the stable McKesson TC product, and probably significant funding as a result. Yes you could argue that McKesson were threatening not to extend support for TotalCare PAS at the time of the Rotherham procurement however you could also argue that with 25 plus Trusts still using it and CFH negotiations to extend the contract on-going that it was unlikely to be a burning platform. TotalCare is supported until March 2014 now I believe.
The point is that Trusts should evaluate what they have with a keen business and clinical eye and really determine why an existing departmental system from a reputable supplier well established in the UK is going to be less capable than a jack of all trades US module of an all encompassing EPR. A lot of Trusts are procuring PAS replacements and are being sold EPR solutions that on the face of it address an immediate need and have the potential to take over other departmental systems, however buyer beware the baby might be going out with the bathwater. How solid is the PAS %u213 PMI and can it deal with UK health requirements with a reference site of similar size here and now?
Clinical portals have the ability to join good departmentals and extend the functional life of other less clinically rich ones by allowing developers to address the gaps either clinical or business ones. As portals tend to grow organically you have the opportunity to involve clinicians at a better pace and at a greater depth of detail without threatening to take away a departmental that meets their immediate need
Its easy looking back?james77 72 weeks ago
brianlee, it is very easy for us all to look back and question the reasons why a Trust chooses a large EPR over any other solution, and certainly very easy for us to shoot it down after the events of implementation. There are two factors compared to what we now know that may have moved Rotherham down a different path if they had a crystal ball at the time 1. McKesson had served notice to the UK market at the time and investment in TotalCare was minimal leaving the Trust with no other option but to look elsewhere, McKesson in buying System C would have now been able to supply Rotherham with a solution, but this is 5 years or so after the events when a decision needed to be made with the Trust faced with a burning platform 2. Looking elsewhere included Lorenzo at the time and Portal solutions were in the early days of development and certainly not in the dialog or mindset of any Trust (the frenzy at the time was large EPR's). Again, that said with or without an integration solution Rotherham needed to look to replace McKesson at a time with little being offered to them by the National Programme.
With regards to Meditech, I am sure they will have had a reference site in the US given their market share (over 50%?) and I believe that clinicians were very much a part of the evaluation team selecting the product at the time.
time and time again...brianlee 72 weeks ago
Rotherham has fallen into every trap an implementation can throw up, almost a classic failure pattern. Starting with buying a US system %u218off-plan%u219 with no US never mind UK reference site.
Meditech is flexible only within US parameters, underneath it all is therefore a configurable system designed to deal with account based transactions. UK constructs don't map easily to it therefore you finish up with a kludge, or a series of such.
The only way out of such a situation is intense training on how to use a modified US product in a UK Hospital and workaround after workaround, to the point where you would be better going back to paper. Given that jobs are to be taken out of Rotherham and one assumes some of those will be at least able to drive the system now, how do they expect things not to get significantly worse? They have had to get more admin staff working longer just to try and keep up with a poor product.
Hospitals in this sort of dark place are actually at a disadvantage to those who didn't go the trailblazer route!? Rotherham had McKesson Totalcare PAS, rock solid on almost every UK specific Health requirement, especially C&B which had gone through years of refinement. They now have technical difficulties with C&B!!! they have now spent millions going backwards whereas local competitor Trusts haven%u219t.
Rotherham is looking at the sharp end of a 3 to 5 year re-learning and re-investment programme (if they are really lucky) to rectify these difficulties just at a time when they can least afford it. Clinical involvement is essential but you have to put SOLID products in front of clinicians that WORK and at least can be seen to improve patient safety and then allow them to shape and develop from that point. You can%u219t sit a clinician in front of a US system that%u219s been hacked to UK standards and expect any constructive evaluation or buy-in.
When will Trusts learn that most of the software tools are out there to integrate current systems and yes, legacy systems, to provide clinically rich products that serve NHS organisations well without investing millions in US monoliths? They can't have asked clinicians what they needed from the system as I am sure what they have now is nowhere near.
Using clinical portal technology and existing systems together with a straight PAS upgrade would have got Rotherham a first class system for a fraction of the 'publicly' stated cost nevermind the reputational damage and lost revenue.
Agreed, but whyIt is I, LeClerc 72 weeks ago
I think you are correct, so it begs the question why did they choose this path? Come to that, why are others still choosing this path, what gives them the confidence that they won't experience the same, familiar problems?
Monolithic EPRs have had their daysNeelam Dugar 72 weeks ago
It is clear that Single Monolithic EPRs Meditech, Cerner, Lorenzo etc.
What is really going to be successful is XDS based VNAs which archive & manage data from multiple departmental systems. With zero-footprint browser based XDS based clinical portal providing clinicians an integrated patient records. GE, Carestream, Fujifilm, Acuo Agfa all can provide this today to NHS.
Clarification please....The mind boggles... 72 weeks ago
A true EPR includes all details pertaining to the patient- clinical and administrative date (emails, word docs, jpegs etc.....) are you sure those vendors you list can manage non clinical content?
times are a changingsteve@optevia 72 weeks ago
There is light at the end of the tunnel - an increasing number of IT services within Trusts are now realising they can respond pro-actively to their clinician internal customers by adopting framework technologies like Microsoft's Dynamics. Where the response from IT used to be to produce a specification and then go out to procurement for a "system" from a supplier that was then bashed into shape (wrong in so many ways) it is possible now to let Clinicians design and subsequently change quickly and easily the communications, scheduling and outputs that they need within the flows of work that they manage - data, web pages, emails, etc. I think we will see some major changes in approach in the next few years...
Different System - Same StoryOzLurker 72 weeks ago
Or to put it another way;
another day - another few million dollars!
I think we can say with some certainty now, implementing major e-Health initiatives at large General Hospitals is VERY difficult, regardless of which system you are using.
Since repeated observation has arguably proven this point, why do we persist with a failed and expensive strategy?
I believe Clinicians have to step up to the plate and not just be engaged, but take control locally. They must work with suppliers to generate systems that users like and that meet the planned work-flows (and for me that does not include writing software code). These systems must be adaptable to rapid clinical and research change. Local IT teams must oversee the implementations technically and facilitate inter-operability between these systems, thus leaving external agencies and Government to set some standards and data return requirements and NOTHING ELSE.
Given the number of reports and papers coming from the US showing that the HITECH initiative has not improved safety, but has increased patient use of healthcare resources and increased clinical use of investigations, thus negating all the often quoted benefits of digital health, to whit; better safety, increased efficiency and cost savings, we really do have to find a better way.
PS Congrats to Mr. Brian James on getting to his retirement after the media scrutiny Rotherham has been subjected to in recent years, you would have got vey long odds on him making it without moving or losing his job!