By Tony Collins
NHS trusts have gone live with Cerner Millennium with mixed success. Eight trust implementations went seriously awry. A list is at the end of this post.
The flawed go-lives have meant that hospital managers have lost track, cumulatively, of thousands of patients and found that treatments, including those for cancer, were delayed or care pathways interrupted. At times medical notes have not been available, or clinicians have been given the wrong notes.
In July 2008 E-Health Insider reported that the deployment of a national programme care records system at Milton Keynes Hospital NHS Foundation Trust “developed into an untenable situation which resulted in near melt down of the organisation”.
One of the lessons from the problematic go-lives is that trusts, when they have reported on the difficulties later, have said they underestimated the risks.
In particular they regarded the patient records system as mainly administrative with no risks to the health and care of patients. Yet it is possible for incidents arising from flawed patient record implementations to be judged “clinical”.
Is Croydon Health Services NHS Trust, which includes the former Mayday hospital, about to repeat this same mistake – of regarding the risks as non-clinical?
The Trust is due to go live this weekend with the start of one of the largest patient record go-lives in the UK. The deployment is being run under the NPfIT, which, in the capital, is now called the London Programme for IT. The plans are to install Millennium at Croydon University Hospital (formerly Mayday) and at some community sites.
The Trust says its preparations are designed to ensure a safe and effective deployment that will replace systems that are more than 20 years old and lack “many of the functions one expects in the modern healthcare digital age”.
But the signs are, from the trust’s board papers, that the risks of a flawed implementation are being seen largely as financial and administrative. For patients it appears that the worst that is envisaged is a “poor experience”.
Have the risks to patients been properly flagged to the board’s directors?
I looked through Croydon’s most recently published board papers to see how well the trust’s directors have been kept informed of the risks of the go-live and could see almost no mention of Cerner – except a risk that income to the Trust could be affected if it is unable to produce timely reports. There is no specific mention of risks to patients.
Given the history of failed implementations of Cerner Millennium under the NPfIT, I asked Croydon Health NHS Trust what directors have been told about the risks.
This was the trust’s reply:
“CRS Millennium has featured regularly on the Corporate Risk Register presented to each Part 1 Board meeting.
“In addition, implementation has received detailed confidential consideration at Part 2 of Board meetings, (which is why you won’t find it in our public board papers).”
I then put it to the trust that I was not sure why, in a new era of openness and transparency in the NHS, that board discussions should be in private on a matter that could affect large numbers of patients to judge from past implementations at other trusts. The spokesperson – the interim stakeholder relations manager – made no further comment.
Richard Granger, when head of the NPfIT, was quoted as saying he was ashamed of some of the Cerner deployments . Granger quit the programme in January 2008 – and since then several more Cerner deployments at trusts have gone badly wrong, at North Bristol NHS Trust, for example.
After the NPfIT go-live of Cerner at the Nuffield Orthopaedic Centre, the National Audit Office, at the request of a member of the Public Accounts Committee Conservative MP Richard Bacon, investigated and produced a public report on the lessons learned.
The Nuffield go-live was in December 2005. Since then managers at all trusts that have gone live with Cerner have claimed they have learned those lessons.
It’s true that Croydon Trust’s risk register has shown “red” for the Cerner implementation. It is indeed deemed “high risk”. But how many of its board directors will understand the nature and substance of the risks to patients from a graphic?
It’s easy for the trust to say that board directors have been informed through confidential discussions but how would anyone outside the trust be able to judge whether that’s true?
Trust boards can never be held fully accountable after a patient record go-live goes wrong. They hold their own investigations or sometimes commission inquiries by consultants known to them, and the final reports usually indicate that no patients have been harmed. Even after a trust has lost track of thousands of patient appointments for more than a year, it has later reported that in the end all was well.
As trust boards are not voted in and out by the public they have a special duty to ensure they are fully informed on things that can go wrong. Is Croydon Health’s board fully informed on the risks of the Cerner go-live? I doubt it.
Some flawed NHS patient record go-lives:
St George’s Healthcare NHS Trust