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Tony Collins

Tony Collins is an investigative and campaigning journalist and former Executive Editor at Computer Weekly. With his friend and colleague David Bicknell he wrote "Crash", which found common factors in the world's largest public and private sector IT-related failures. He wrote "Open Verdict", a book on the strange deaths of defence scientists. He writes, and gives talks, on the tensions and disputes between suppliers and users.

An NPfIT, BT and Cerner go-live success?

A go-live of a Cerner Millennium patient records system under the NHS IT programme at Croydon Health Services NHS Trust, is officially a "success". But is it?

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BT and Cerner have praised the go-live of the Millennium patient records system at Croydon Health Services NHS Trust as "one most efficient roll-outs of the system they have worked on," according to the trust's chief executive John Goulston.

The implementation at the end of September 2013 was under the London Programme for IT - a branch of the National Programme for IT, which is now being run by the Health and Social Care Information Centre .  The HSCIC was the Croydon trust’s partner for the Cerner go-live.

In a report to the trust board two weeks ago Goulston said that Croydon deployed the “largest number of clinical applications in a single implementation in the NHS”. He said:  

“Our partners Cerner, BT and Ideal have commented that the Trust has undertaken one of the most efficient roll-outs of the system they have worked on, with more users adopting the system more quickly and efficiently than other trusts … the success we have achieved to date is the result of the efforts of every single system user and all staff members,” said Goulston.

But the implementation has not been without serious problems, which are mentioned briefly in the trust's latest board papers, dated 25 November. The papers refer to:

Network downtime and waiting time breaches. "CRS Millennium (Cerner) Deployment -Network downtime - Week 1.  In particular, the significant network downtime in week 1 (BT N3 problem) led to no electronic access to Pathology and Radiology which resulted in longer waits for patients in the Emergency Department (ED) leading to a large number of breaches. This was a BT N3 problem which has been rectified with BT providing CHS with the required scale of N3 access (>600 concurrent users and >1,600 users on any day - which is the largest network usage of any trust in England).”

- Excessive waits in A&E. "The main drivers adversely affecting the performance in the month [October 2013) for A&E were the deployment of CRS Millennium and the commencement of winter pressures due to the seasonality change.  A&E  4-Hour Total Time in Department Target: 95.00%. Actual: 91.57%.”

- Over budget. “The Trust position as at October is an adverse variance of £4.1m. This is a significant deterioration on the Month 6 position. The movement is mainly due to a significant reduction in income mainly as a result of operating issues caused by the Cerner deployment (£0.9m)...  Actual £14.8 (£14.8)m; Budget £10.7m; Variance £4.1m... Cerner Millennium: Plan YTD [year-to-date] £245,000; Actual YTD  £621,000;

Significant loss of income. “A new patient administration system was deployed in the Trust on the 30th September and 1st October (Cerner Millennium). The deployment has resulted in significant loss in income in September and October £ 1.1m. Trust performance on Activity Planning Assumptions and Key Performance Indicators is substantially worse than plan …”

Extra costs. "Medical £412k and admin £148k agency levels continue to be high due to cover for vacancies, annual leave, sickness and release of staff for Cerner training. The Trust has also incurred additional costs associated with the Cerner deployment (£600k) including overtime payments to administration staff and training costs.”

- Bid to recover Cerner costs. “… The Trust is currently forecasting a deficit position of £17.8m, which is £3.3m off the plan submitted to the NHS Trust Development Authority. This is a £3m movement from the month 6 forecast and is as a result of operational issues caused by the Cerner deployment. The current projected impact is an additional costs £1.7m and a loss in activity £1.1m . An application is to be made to recover the additional cost/losses relating to the Cerner deployment [of £2.9m] …”

HSCIC support for delays. “Cerner Millennium - Revised implementation date to Sept 2013 (achieved) ,with resultant additional costs including additional PC requirements of £146k, specialist support services £300k, procurement costs £91k, data cleansing costs £200k...Health& Social Care Information Centre (HSCIC) has confirmed support for the delayed implementation will be provided, accounting treatment of support to be confirmed with Department of Health.”

More money to stabilise operational position?  “As a result of operational issues caused by the Cerner deployment , Income is significantly reduced in October. The forecast assumes that the Trust will resume normal operating levels from November and that an element of the income lost will be will be recovered in the latter part of the year. A business case is being submitted to the Trust Board for additional investment in Cerner to stabilise the operational position.

“If there are further operational issues due to the Cerner deployment then this will significantly impact on the year end forecast…”

Over-optimism? Principal risk -reporting output from Cerner is not accurate or timely. Officer in charge: CEO. Before go-live risk scores: June 2013 - 16; July - 16; Aug  - 10; Sept - 10. After go-live risk score (for Oct): 20 [high risk of likelihood and consequences]

There are brief references to the problems in various board papers. The trust has not published any specific report on its Cerner implementation difficulties.  

MP Richard Bacon, a member of the Public Accounts Committee, has called on Croydon Health Services to be more open about the problems it has faced since the Cerner go-live.

"Patients need to know that Croydon takes a duty of candour seriously. If the Trust cannot be open about its IT-related problems, how can we be sure it will be open about anything else to do with patient safety?”

Trust response

A spokesman for Croydon Health Services NHS Trust said:

“The Trust board has been given regular reports on the roll out of CRS Millennium and any potential risks throughout the process, not least through its regular reviews of the Corporate Risk and Board Assurance Frameworks... the board received a specific update in September.

“... November’s board meeting received a further update from the Chief Executive.  The papers from this meeting were published and the meeting takes place in public;  Those attending are invited to put forward questions.

“A meeting chaired by the Chief Operating Officer continues to review operational matters.  This is an internal meeting for clinicians and managers which has informed the implementation process;

“Patients and visitors to the hospital have been kept fully appraised of the introduction of the system and were made aware that they may experience some delays to the check-in process while staff became familiar with the new computer system;

“...Cerner & BT noted that ‘the Trust has undertaken one of the most efficient roll-outs of the system they have worked on’   The papers also note some operational challenges as the system was rolled out.  These have been addressed as part of the daily meetings I reference above - these are mainly concerned with users familiarising themselves with the system and have been addressed through the support and training staff received.

“In terms of the costs, the introduction of CRS Millennium has been supported by central funding from the Department of Health with the Trust paying the implementation overheads.   These costs are a matter of public record and the Trust publishes annual Accounts as part of its Annual Report.”

More on Croydon's Cerner Millennium go-live at at Campaign4Change

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