Cerner system “too entrenched to be scrapped”

By Tony Collins

A report by Deloitte on problematic Cerner installations at some hospitals in Australia calls for the government to appoint a chief medical information officer to oversee computer projects across the State.

The Deloitte report is a reminder that new IT in hospitals can have good – and adverse – safety implications for patients.

Obtained by the Sydney Morning Herald under Australia’s Freedom of Information Act, the Deloitte report is said to accept complaints last year that the system put patients’ health at risk by providing insufficient alerts to clinicians when messages did not reach their destination.  Deloitte found no evidence of harm to patients.

Though the Deloitte report is specific to the Cerner “FirstNet”  system as installed at some emergency departments in New South Wales, the idea of a chief medical information officer is arguably a good one for the UK where the Department of Health’s CIO (currently Katie Davis, interim Managing Director, NHS Informatics) is not responsible for the medical implications of IT go-lives in NHS hospitals.

New systems bypass the sort of regulation that helps protects the public against harm from medical devices. After hospital IT disasters there is no requirement for a genuinely independent investigation, as happens after airline crashes.

The Sydney Morning Herald [SMH] reports Deloitte as saying that the FirstNet system, which was installed to help run emergency departments across New South Wales, is chronically underfunded.

Deloitte was asked to report on the system after some hospital staff last year lost confidence in the software and returned to manual record-keeping.

Despite continuing problems and excessive time spent on data entry, the FirstNet system is too entrenched to be scrapped and the government should instead invest in bringing it up to scratch, said Deloitte.

”With some exception, FirstNet reporting is inadequate for effective governance of [emergency department] operations,” said Deloitte as reported by the SMH.

Nurses and doctors had complained that the system increased the amount of time they spent at a screen and reduced contact with patients. But the Deloitte report said more time spent on data entry ”was essential to realise the eventual benefits of an eventual [electronic medical record]”, such as greater accuracy of test results and medicine orders.

Upgrades were improving safety at some hospitals but needed to be across the state.

The government should appoint a chief medical information officer to oversee computing projects across the state, and pay for continuing development and training for FirstNet, said Deloitte.

The Health Minister, Jillian Skinner, said clinicians did not want to scrap FirstNet because they didn’t “want to start anew”.

The list of hospitals that have had serious problems after IT installations is growing, in part because the increasing use of technology in healthcare. Though hospital staff tend to learn in time to manage new systems, the unanswered question is whether patient care and treatment – and potentially their health and safety – should be damaged in an unregulated way until the problems are solved or mitigated.

Below is the UK list where it is known that the installation of new IT has caused serious disruption.  Any effect on individual patients has gone unreported:

Barts and The London

Royal Free Hampstead

Weston Area Health Trust

Milton Keynes Hospital NHS Trust

Worthing and Southlands

Barnet and Chase Farm Hospitals NHS Trust

Nuffield Orthopaedic

North Bristol.

St George’s Healthcare NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

Birmingham Women’s Foundation Trust

NHS Bury



Does Hospital IT need airline-style certification?

Hospital computer system found lacking – Sydney Morning Herald

Jon Patrick’s essay on the effectiveness and impact of Cerner’s FirstNet system in some hospitals in New South Wales.

2 responses to “Cerner system “too entrenched to be scrapped”

  1. Pingback: IT crisis management – an ongoing case study | Campaign4Change

  2. Its 2012 and still “greater accuracy of test results and medicine orders” is trundled out as a reason for doing Big IT! This was the stated benefits in 1990 when I got into healthcare IT.

    There are truths in IT that the health service seems to ignore: garbage in, garbage out; if its not broken don’t fix it, to name but two light-hearted ones. The type of benefits realisation that is required to show true cost saving and improved patient care will never ever be achieved by just putting in a new IT system. Look at NPfIT; in fact look the world over. I am going to be contentious. This stuff is not difficult; complex maybe, but not difficult. The main problem in the man machine eco-system is man. Let’s face it, the education system does not churn out healthcare professionals with an understanding of the importance of timely accurate information. Quite frankly I am glad, as I want the healthcare professionals treating me to be masters of their trade and not a Jack of all. Big SI sells big dreams with big numbers attached and some of us buy into it hook line and sinker because we think it’s what we want. [edited]


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