Category Archives: health records

How London IT director saves millions by buying patient record system.

Posted on 07/06/2012 | 4 comments

By Tony Collins

An NHS organisation in London has bought an electronic patient record system for less than a third of the cost of similar technology that is being supplied by BT to other trusts in the capital and the south of England.

The £7.1m purchase by Whittington Health – a trust that incorporates Whittington Hospital near Archway tube station – raises further questions about why the Department of Health is paying BT between £31m and £36m for each installation of the Cerner Millennium electronic patient record [EPR] system under the NPfIT.

Whittington Health is buying the Medway EPR system from System C which is owned by McKesson. The plan is for the EPR to operate across GP, hospital and social care boundaries.

It will include a patient portal. The idea is that patients will use the portal to log on to their Whittington Health accounts, see and save test results and letters, and manage outpatient appointments on-line.

In a board paper, Whittington Health’s IT Director Glenn Winteringham puts the case for spending £7.1m on a single integrated EPR.  Winteringham puts the average cost of  System C’s Medway at £8m. This cost, he says, represents “significant value for money” against the average deployment costs for the NHS Connecting for Health solution (Cerner Millennium) for London of £31m. In the south of England the average cost of Cerner Millennium is £36m, says Winteringham in his paper.

He also points out that the new EPR will avoid costs for using “Rio” community systems. The NPfIT contract with BT for Rio runs out mid 2015. “From this date onwards the Trust will incur an annual maintenance and support cost. Implementing the EPR will enable cost avoidance to the [organisation] of £4m per year to use RIO (indicative quotes from BT are £2m instance of RIO and the [organisation] has 2 – Islington and Haringey).

BT’s quote to Whittington for Rio is several times higher than the cost of Rio when supplied directly by its supplier CSE Healthcare Systems. A CSE competitor Maracis has said that, during a debrief, it was told that its prices were similar to those offered by CSE Healthcare for a Rio deployment – then less than £600,000 for installation and five years of support.

In comparison BT’s quote to Whittington for Rio, as supplied under the NPfIT, puts the cost of the system at more than fifteen times the cost of buying Rio directly.

In short Whittington and Winteringham will save taxpayers many millions by buying Medway rather than acquiring Cerner and Rio from BT.

Why such a price difference?

The difference between the £31m and £36m paid to BT for Cerner Millennium and the £8m on average paid to System C could be partly explained by the fact that Whittington (and University Hospitals Bristol) bought directly from the supplier, not through an NPfIT local service provider contract between the Department of Health and BT. Under the NPfIT contract BT is, in essence, an intermediary.

But why should an EPR system cost several times more under the NHS IT scheme than bought outside it?

Comment:

Did officials who agreed to payments to BT for Cerner and Rio mistakenly add some digits?

Whittington’s purchase of System C’s Medway again raises the question – which has gone unanswered despite the best efforts of dogged MP Richard Bacon – of why the Department of Health has intervened in the NHS to pay prices for Rio and Cerner that caricature profligacy.

Perhaps the DH should give BT £8m for each installation of Cerner Millennium and donate the remaining £21m to a charity of BT’s choice. The voluntary sector would gain hundreds of millions of pounds and the DH could at last be praised for spending its IT money wisely.

Whittington buys Medway and scraps Rio – E-Health Insider

NHS IT supplier “corrects” Health CIO’s statements

MP seeks inquiry into BT’s £546m NHS deal

NPfIT go-live at Bristol – trust issues apology

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Posted in Campaign4Change, cost avoidance, Government IT, health, health records, IT and the Business, IT projects, managing outsourced services, NHS, npfit, reducing cost strategically, supplier relationships

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Healthspace was failing in 2010 – why is it being kept alive?

Posted on 25/05/2012 | 2 comments

By Tony Collins

“Too many failing projects are continued for too long” – Ian Watmore, House of Commons, 2009.

HealthSpace, a centrally-run system that has, for years, provided unneeded work for consultants based at Connecting for Health, software developers, civil servants, and IT suppliers,  at a cost of tens of millions of pounds, is to close “from” March 2013.

A report commissioned by the Department of Health and NHS Connecting for Health in 2010 found that the system had never worked satisfactorily. But the Department and CfH has kept the project going, paying consultants and IT suppliers, although it was clear from an early stage that the scheme was doomed.

Will the Department of Health continue paying consultants and IT suppliers for a system that is to be cancelled?

HealthSpace was designed to be a personal health organiser. It was based on a good idea – that some patients could benefit from access to their health records – but the technology was too complicated and never fit for the public to use. It is said that those involved in the project spoke in a technological, managerial and procurement language – and rarely mentioned patients.

The Guardian this week reports Charles Gutteridge, national clinical director for informatics at the Department of Health, as saying that Healthspace is “too difficult to make an account; it is too difficult to log on; it is just too difficult.”

The Department of Health later told The Guardian that Healthspace would be closed down “from” March 2013.

In 2010 a report by Trisha Greenhalgh and her team, The devil’s in the detail, which was commissioned by CfH, found that HealthSpace had involved professional advisers, software developers, security testing contractors, business managers who wrote the benefits realisation cases, lawyers who advised on privacy and regulatory matters and many others.

Yet the system was doomed from the start. Greenhalgh’s report in May 2010 revealed that:

“Project leads from participating NHS organisations repeatedly raised concerns with Connecting for Health in monthly management meetings about the low uptake of advanced HealthSpace accounts, since the benefits predicted, such as lower NHS costs and patient driven improvements to data quality, could not possibly be achieved unless the technology was used.”

Comment:

It’s not known how many millions has been wasted – and continues to be wasted – on Healthspace; and it is difficult to avoid the conclusion that the continuance of the scheme benefits nobody except those who are paid to work on it, which includes contractors and IT suppliers.

Why is the scheme to be cancelled “from” 2013, when it should have been cancelled when Trisha Greenhalgh and her team produced their report in May 2010?

Shouldn’t ministers have some control – especially given that we are supposed to be in an age of public sector austerity? Ian Watmore, Permanent Secretary at the Cabinet Office and former Government CIO, has said that failing projects are continued for too long. He said that in 2009. So isn’t it time ministers and particularly civil servants applied the principle of ‘fail early, fail cheaply‘?

Link:

In 2010 ComputerworldUK had an account of how Healthspace was being kept alive unnecessarily.

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Posted in Campaign4Change, e-health, excessive secrecy, Government IT, health, health records, IT projects, IT-related failures, NHS, npfit, supplier relationships

Summary Care Record plods on

Posted on 11/04/2012 | Leave a comment

By Tony Collins

Pulse reports that the Summary Care Record database had 13.1 million records by 22 March 2012, which is around the number the DH had expected for April last year.

It reports that the figures have prompted David Flory, deputy NHS chief executive, to call for ‘rapid further progress’ on the rollout.

In his latest quarterly report on NHS performance, Flory highlighted the SCR as an area for improvement. “Implementation does not meet expectations and rapid further progress is needed,” said Flory. “While performance has improved, the rate of this improvement is beneath the expected trajectory.”

The number of patients with an SCR has almost doubled from around seven million a year ago. Sixteen PCTs have more than 60% of patients with an SCR.

Critical Mass

In February, Kilburn GP and SCR director Gillian Braunold was reported in Pulse to have said the rollout has reached a ‘critical mass’ in some areas. Out-of-hours providers, and those in urgent care and hospitals are viewing about 1,600 records a week.

Braunold said information within the SCR was changing some therapeutic decisions. She also said there was also evidence from areas where end-of-life care plans had been uploaded to care records that more patients were dying in their preferred place.

Nurses at NHS Direct are to have access to care records and the DH is working on plans to replace HealthSpace and enable patients to access their full patient record.

Comment – The devil’s in the detail

It is difficult to put Dr Braunold’s comments into context without published independent evidence of which there is little or nothing that’s recent.

In public, NHS Connecting for Health has never wavered in proclaiming the success of the SCR but it has sought to control authoritative information on the SCR programme.

CfH commissioned an independent UCL report on the NPfIT SCR  “The devil’s in the detail”, but asked researchers to, for example, delete the cost of the SCR programme. CfH also removed passages from official SCR documents it gave the UCL researchers.

The final UCL report , which said in a footnote ” financial data deleted at the request of CFH”,   found that there were inaccuracies in the SCR database. UCL researchers also learned that the SCR database could not be relied on as a single source of truth.

Some CFH staff found the notion of possible ‘disbenefits’ of the SCR difficult to conceptualise, said the UCL report.

There is no doubt that an accurate and well-populated SCR would be useful, especially for out-of-hours doctors. They need to know – at least – what drugs patients are taking and what if any adverse drug reactions they have had.

As the DH tells patients: “Giving healthcare staff access to this (SCR) information can prevent mistakes being made when caring for you in an emergency or when your GP practice is closed.”

But a national database is not the way forward. It is unlikely to be trusted as accurate or up-to-date. It would be better to give patients and clinicians access to locally-held NHS-sourced information. We’ll report more on this separately.

Meanwhile the SCR plods on at a high cost – more than £220m so far. BT, the SCR’s main supplier, will be pleased the programme is continuing, as will those civil servants and consultants who have been involved with the programme for several years. But whether the database is of real value to doctors and patients we don’t know for certain. The DH tends not to publish its independent advice.

Summary Care Record a year behind schedule, DH warns – Pulse

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Posted in Government IT, health, health records, IT projects, IT-related failures, managing change, managing outsourced services, NHS, npfit, openness and transparency, operational issues, Politics

IT crisis management – an ongoing NHS case study

Posted on 20/03/2012 | 2 comments

By Tony Collins

When a public-facing go-live goes wrong should communications be neutral in tone – or accentuate the positive?

On 8 December 2011 North Bristol NHS Trust went live with the Cerner Millennium electronic patient records system under the NPfIT programme.

At first Trust staff thought the difficulties were confined to a mix-up over outpatient appointments but it later transpired that there were 16 “clinical incidents” between 1 December 2011 and 17 January 2012 that were related to the Cerner Millennium implementation.

The Trust has published regular public information notices on the benefits, expected benefits, and problems arising from the Cerner implementation.

Reassuring in tone, the notices have made no mention of anything more potentially serious than administrative “issues”:  non-existent appointments were set up and letters sent to patients in error. The notices said that though the “issues” caused disruption and frustration, patient safety had not been compromised. The Trust apologised to staff and patients.

Clinical incidents

No mention was made in the notices of staff having reported clinical incidents in which the new patient records system was a causal factor. The NHS usually categorises  each clinical incident as a  “near miss” or “actual harm”.

In Campaign4Change’s various conversations with the North Bristol Trust over the potential seriousness or otherwise of its IT problems, one thing has been clear: it is pleased with the level of public information it has given out over the problems:

–       regularly-updated messages on its website,

–       briefings to the media including interviews for regional BBC and ITV channels by Ruth Brunt, the Trust’s chief executive,

–       board papers,

–       on-time answers to requests under the Freedom of Information Act

–       leaflets and posters placed in outpatient clinics and on car parking machines explaining that the Trust was implementing a new computer system and apologising for any delays patients may experience

The Trust also gave GPs a dedicated telephone number, fax number and email address for GPs or their patients to contact for further advice.

Profuse public information

We agree that the Trust has run a diligent public information campaign; and its communications staff have always responded quickly to our calls –  and with the documents we requested. The staff were frank in answering our questions. They told us that no decision has been taken yet on whether the Trust will publish the results of an independent inquiry into the Cerner implementation.

But if the Trust doesn’t publish the lessons from its Cerner implementation, it may wish to be reminded of a warning by the Local Health Board of Merthyr Tidfil, at the top on its Clinical Incident Reporting Policy paper: –  To err is human; to cover up is unforgivable; to fail to learn is inexcusable.         

If the Trust does not publish how will others learn from its mistakes?

Accentuate the positive?

The quantity of public information released by North Bristol NHS Trust is not an issue – but how informative is  it? Does the wider culture of the Trust still force staff to accentuate the positive?

The first of the Trust’s website statements on the problems of the Cerner implementation came about five weeks after the go-live. The opening sections of the statement made no mention of any problems. Indeed a series of bullet points listed the benefits of the system:

  • Patient records will now be securely stored electronically on a single system, replacing paper records.
  • Authorised clinicians can quickly find and share information on patients and their medical history and no longer rely on paper filing records.
  • Clinicians will also be able to access records at the patient’s bedside and can input information and statistics immediately.
  • Patients will no longer have to repeat their details to different clinicians as they will be accessible in one place.
  • Tests and outpatient appointments can be set up immediately with the patient.

The Trust’s website statement went on to say that “many”wards as well as A&E at Frenchay Hospital [Bristol] are using the new system.

Only if you’ve read this far will you see a reference to problems.

“However, we have experienced some unexpected problems in the last few weeks with outpatient appointments…”

“Huge improvements”

The current media statement is, again, more upbeat than neutral.  The vague mention of problems is countered by the equally vague claim of “huge” improvements.

“At North Bristol NHS Trust we have been implementing a new electronic patient record system to replace an outdated, less efficient system. Our wards, two minor injuries units, the Emergency Department, theatres and maternity are using the new system.

“However, we have experienced some unexpected problems with some of our outpatient clinics resulting in non-existent appointments to be set up and letters sent to patients in error. Our priority is always patient safety and we are clear that this has not been compromised.

“These issues have caused disruption and frustration for our patients and our staff and we recognise that this has not delivered the level of service that we expect, and the public expect, from us. We apologise wholeheartedly for that.

“Our staff have shown real commitment, hard work and dedication to continue to deliver patient care. Our Information Management & Technology Team worked very hard to rectify these problems as quickly as possible and we have seen huge improvements.

“The system in all outpatient clinics has now been rebuilt and relaunched. These clinics are now in a position to effectively use the new electronic records system. We anticipate there will be a further transition period for staff in those clinics. We firmly believe that the new system, once fully implemented, will improve services for our patients and provide real value.”

Campaign4Change pointed out to North Bristol that board papers on the troubled Cerner implementations at Barts and The London were commendably detailed and informative.

Barts had referred breaches of government targets on waiting times, complaints from patients, delays in the reporting of statutory and other trust performance information, extra costs, losses of income because of reduced activity, and the effect of data errors. There has been little of any of this from North Bristol’s public information campaign.

Freedom of information

Indeed North Bristol has refused to answer questions that were asked under the FOI Act by D Haverstock of the South West Whistleblowers Health Action Group.

The Trust refused Haverstock’s requests for:

–        a copy of your Cerner implementation plan, including pilot

–        the criteria on which the go-live decision was taken

–       a copy of the issues log for the implementation, with a full history of closed and open items.

–        reports on Cerner Project Board/Steering Committee meetings.

The Trust did give Haverstock a vague answer to her question on whether the Trust will have to take over the running costs of Cerner from 2015 when the Department of Health’s NPfIT contract with BT ends.

The Trust said the running costs for Cerner will become the Trust’s responsibility from October 2015 – but it doesn’t know for certain what the costs will be.

“The exact costs are still being calculated, but will be around the same levels as our previous patient administration system, we estimate,” said the Trust.

North Bristol declined to answer Haverstock’s other questions because “at this time the Trust feels that to answer your questions regarding the Cerner Millennium implementation would compromise our position with BT and Cerner”.

Rightly, Haverstock challenges the Trust’s use of the word “feels”. Rejections of FOI requests should be based on facts not its feelings.

Says Haverstock in her request to the Trust for an internal review: “Subjective feelings are not a valid reason for rejecting an FOIA request. What is your objective, evidence base for rejecting this request? [Thank to Theyworkforyou.com for this information.]

Comment

Poorly-designed health IT can kill, according to a US Institute of Medicine report “Health IT and Patient Safety Building Safer Systems for Better Care” in November 2011.

The report says:

“Poorly designed health IT can create new hazards in the already complex delivery of care.

“Although the magnitude of the risk associated with health IT is not known, some examples illus­trate the concerns.

“Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death …”

There’s no evidence that the problems at North Bristol have caused any harm to patients. Indeed the Trust, in reporting the clinical incidents in response to a BBC’s reporter’s FOI request, says its “robust safeguarding processes, as well as additional checks and balances in all departments” have “ensured that clinical safety was not compromised and no patients were put at risk”.

It adds: “Our priority is always patient safety and there is no indication that this has been affected.”

But would we know if patient safety had been affected? In its public information campaign the Trust has been prolific. But the accent on the positive, rather than a neutral and factual account of the specific problems, has left us with little confidence that all the truth has yet come out.

In an IT-related crisis it is not a mass of information that the public and media regard as helpful but specific answers to specific questions. Has North Bristol managed its IT-related crisis well? Up to a point, Lord Copper.

MP questions costs of North Bristol Cerner system

Sir David Nicholson challenged on North Bristol’s Cerner costs

North Bristol system has more problems than anticipated.

North Bristol hits appointment problems

Cerner system “too entrenched” to be scrapped.

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Posted in change management, health, health records, IT projects, managing change, NHS, npfit, operational issues, outsourcing, Politics, procurement, project management, public sector, public services, supplier relationships

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Lessons from “stupid” NHS IT scheme – Logica boss

Posted on 13/03/2012 | 1 comment

Some wise words from Andy Green, CE of Logica, on lessons from the NPfIT and other failures

By Tony Collins

Andy Green, CE, Logica

Andy Green, chief executive of Logica, speaking to the BBC’s Evan Davis about the NHS National Programme for IT, NPfIT, said:

“It is a stupid thing for the supply chain to have answered, and it’s a stupid thing for the customer to have asked for.”

Green was speaking on Radio 4’s The Bottom Line about corporate “cock-ups and conspiracies”. Other guests were Phil Smith, chief executive of Cisco UK and Ireland, and entrepreneur Luke Johnson.

Green, who joined Logica as CEO in January 2008, said he was in one of the bidders for the NPfIT when he was at BT.

The plan, he said, had been to put the same system into every hospital but later foundation hospitals were able to opt out of the NPfIT.

“Half way through [the NHS IT programme] foundation hospitals were invented,  and suddenly foundation hospitals did not have to go with what the NHS said at all”.

He added: “There were fundamental errors in the whole procurement process, and then real difficulty in delivering what had been promised.”

Evan Davis said the NHS IT scheme had cost billions, achieved little and had been running for years. He asked Green: “What’s the story?”

Green said some things went well including the supply of a network that connects pharmacies and doctors. But …

“What  had been promised by the supply chain was fantastic software that had not been designed yet that was going to completely revolutionise hospitals and delivering that proved to be horrendous… in the end it is foolish to set out on a programme that is going to take seven years with a fixed procurement up front, which says we all know everything about it …”

Lessons

Green spoke of the need for the supplier to understand exactly what the customer wants and whether it is deliverable before the parties agree to draw up a project specification.

“I think the world is beginning to learn about incrementalism. Let’s do something that we can all see and understand.

“Some of our clients we now work with in common teams – we call it co-management – and only when we have worked out exactly what is going to work in the client, and we can deliver, do we specify it as a project.

“Those things tend to go a lot better. We have got used to the fact that we don’t know everything.”

Luke Johnson

Luke Johnson, who is a former chairman of Channel 4, criticised IT suppliers for not getting it right often enough.  “I have bought quite a lot of projects and been involved as a customer many times… As a customer it is a very scary thing because clearly you are not an expert. Your providers are experts and yet they do not seem to be able to get it right often enough it seems to me, given how much they charge.”

Green said there is a high failure rate in the IT industry. “The client sets out one view at the beginning and then they have to change. The sensible defence to this is the partitioning into smaller items and relationships.

“We bluntly always think of our clients over the long run. You need to know people so that you can sit down and have a decent conversation. Too often when these things start to go wrong everybody runs for the contract. Experienced buyers and sellers do not do that: they run for each other and they talk it through, and they work it out, and they put it back on track.

“It’s value that matters. It’s doing something that really changes Patisserie Valerie’s business. [Luke Johnson is chairman of Patisserie Valerie.] What can you do that would transform that. If you can get that done, then if it over-runs by 20% it probably does not matter.”

Luke Johnson: “It depends how much money you’ve got.”

Lowest-price bids

Phil Smith, Cisco

Phil Smith of Cisco said government often has the biggest problems because “they squeeze so much in procurement there is little good value and goodwill left”.He said that on good projects problems are tackled by cooperation but “if every piece of value has been squeezed out before you procure it, your only option is to get something back from it”.

Beware procurement experts

Johnson said if procurement experts take control, and their mantra is to save money, it can often lead to trouble. “I fear that in many aspects of business, it gets down exclusively to price rather than value.

“Quality is out the window. They [procurement experts] can show a saving so they have justified their bonus but the supplier may be rubbish.”

Green said government is in a difficult position when a project starts to go wrong. “You are stuck in a procurement and the poor individual responsible is almost certainly facing a union or a consumer group or a doctor who doesn’t want the thing to happen anyway.”

Evan Davis made the valid point that the costs of projects in the public sector have to be underestimated to get approved. Realistic estimates would be rejected as too costly.

“… The person who is championing this project has to demonstrate to superiors that it is not too expensive. It is only by taking the cheapest bid and starting the thing off that you can sell the project higher up and of course down the line it costs a heck of a lot more.”

Luke Johnson: “We all know in many sectors there are providers that will take things at cost or even less with a view that they will somehow bulk it out and make a margin on the way. They know the client will need variations.

Innovation means taking risks

Luke Johnson: “If you want an innovative society, if you want one that is willing to take risks, to generate new technologies, new jobs, new businesses, then it involves failures and cock-ups.

“I think the British have got vastly better in recent years in accepting that as part of the journey and that is incredibly healthy.”

BBC R4’s The Bottom Line – Cock-ups and conspiracies.

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Posted in Campaign4Change, change management, Government IT, health records, IT projects, IT-related failures, managing change, managing outsourced services, NHS, npfit, operational issues, private sector lessons for the public sector, procurement, project management, supplier relationships

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Ambitious health records IT project bags US budget increase

Posted on 24/02/2012 | 1 comment

By David Bicknell

Electronic health records appear to be the three magic words to help unlock an increase in your IT budget, especially if you’re looking to deliver a groundbreaking health IT project for US services veterans.

According to this story,  the Department of Veterans Affairs (VA) would see a 6.9% increase, with much of the money being spent on improved electronic health records. The 2013 budget proposal put forward by the Obama Administration would see $3.3bn being spent on IT, a $216m increase over the current budget.

2012 will see major investment in an ongoing IT project to integrate Department of Veterans Affairs health records with Department of Defence health records. Currently, more than 100 VA employees are working on the programme, with over 20 projects in planning mode, including single sign-on and a plan to unify VA and DOD pharmaceutical systems.

Department of Veterans Affairs press release referring to IT budgets

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Posted in Government IT, health records, IT projects, US Government

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Cerner system “too entrenched to be scrapped”

Posted on 22/02/2012 | 2 comments

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

**

Links:

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.

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Posted in Cerner, health, health records, IT projects, managing change, managing outsourced services, NHS, npfit, operational issues, Politics, public sector

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Can officials stop TPP offering gifts to GPs?

Posted on 10/02/2012 | 3 comments

By Tony Collins

On 13 July 2011 CSC gave this written assurance to NHS Connecting for Health at its headquarters in Leeds.

“CSC can confirm that its subcontractor TPP will no longer be sending out letters to practices offering  gifts in return for organising demonstrations of SystmOne.”

TPP has continued to offer gifts, and the Department of Health is now concerned enough to divulge the letters it has sent to CSC.

It can do little more, for GPs are not bound by NHS rules on the acceptance of gifts.

NHS Connecting for Health became involved after TPP sent out a letter in April 2011 offering tea at The Ritz or two tickets to a West End show of the GP choice.

“All we ask for in return is a short slot at your [local practice manager] meeting so we can demonstrate the benefits of SystmOne,” TPP said. “We’re [sic] a proven system and a real alternative to EMIS and Vision. With a third of the country’s patient records and more than 90,000 users, SystmOne is the leader in hosted clinical systems.

“Following recent success in the London area, TPP are looking to sponsor local practice manager meetings. We’ll provide lunch and refreshments for all your attendees. As a thank-you the organiser of the event will will also receive afternoon tea at The Ritz or two tickets to a West End show of their choice …Don’t wait around for an alternative that might not arrive – SystmOne is available, right here, right now…”

SystmOne is supplied to the NHS by CSC under the National Programme for IT, at a cost to taxpayers that remains confidential under NPfIT contracts. GPs can also buy the system directly under GP Systems of Choice. Some PCTs are said to be putting pressure on GP practices to replace existing systems with SystmOne.

Three months after TPP’s “tea at The Ritz” letter, on 6 July 2011, NHS Connecting for Health’s Programme Director, GP IT, wrote to CSC.

Dear Sirs

GPSoC [GP Systems of Choice] Marketing Activity by Subcontractor (TPP)

It has come to the attention of the Authority [Connecting for Health/Department of Health] that TPP have been sending letters to practices which include offers of gifts in return for organising meetings of practice managers  during which SystmOne would be demonstrated. The gifts on offer include tea at The Ritz, two tickets to a West End show and £50 of Marks and Spencer vouchers.

The activities being carried out by TPP state that they are in relation to the provision of SystmOne through GP Systems of Choice. As the Supplier of SystmOne under the Framework Agreement, the Authority requests that CSC review these activities and provides a response to the Authority, by no later than 13 July, to advise whether TPP, as their subcontractor, will be continuing with such activity.”

CSC’s Primary Care Product Executive replied on 13 July:

“CSC was not aware of such activities being undertaken by TPP and immediately entered into dialogue with TPP.

CSC can confirm that its subcontractor TPP will not be sending out letters to practices offering gifts in return for organising demonstrations of SystmOne.”

In December 2011 Campaign4Change learned that TPP was offering £25 Marks and Spencer vouchers to GPs in return for a “short slot at your meeting so we can talk to you and demonstrate the benefits of SystmOne”. By that time TPP put the number of its users at more than 100,000.

We asked the Department of Health in December 2011 whether it approved of TPP’s incentives. It replied:

“We were made aware and asked the supplier about this activity. The supplier has subsequently confirmed that they have ceased offering incentives to GPs.”

Then we learned of a TPP offer of Hotel Chocolat chocolates.

“Happy Christmas and a Happy New Year from TPP.

“To find out why 1800 GP practices have already moved to SystmOne, just call me on the number below to book your short GP demo. Book before 24th December to get a box of Hotel Chocolat chocolates on the day of your demonstration…”

This month, February 2012, TPP sent out this message:

TPP sponsorship for your practice meeting

“TPP are looking to sponsor your practice manager meeting! We’ll provide lunch and refreshments for all of your attendees. As a thank-you, the organiser of the meeting will also receive £25 Marks and Spencer vouchers! All we ask for in return is a short slot at your meeting so we can talk to your attendees and demonstrate the benefits of SystmOne to those practices not yet using it. Anyone that books a SystmOne demonstration on the day of the meeting will also recieve £25 Marks and Spencer vouchers!

“You already know all the great reasons to move to SystmOne, why not share them with other practices in your area? The more practices that move to SystmOne, the more benefits you’ll see.

“To arrange sponsorship for your next meeting and take advantage of this great offer, just contact us on the number below or reply to this email.”

We asked DH why it had suggested that the gift offers had ceased when they hadn’t. Its reply:

“The Department contacted CSC (as the GPSoC supplier) about this activity by their subcontractor TPP. CSC confirmed that TPP would cease offering gifts to GPs in return for organising demonstrations of SystmOne. We have contacted CSC about TPP’s position which is not in line with the assurances previously provided.”

We also asked the DH why it was concerned about the gifts. It did not reply directly but sent us copies of the letter it had sent to CSC, and CSC’s reply.

Is the DH powerless to stop TPP offering gifts?

TPP told Pulse this week:  “We momentarily stopped offering the incentives over Christmas but will be resuming during February … The incentives were offered only to GPs and practice managers and were completely optional.

“Our ‘Tea at the Ritz’ offer actually costs considerably less than the cost of catering for such a practice meeting. We at TPP appreciate that GPs and their staff are extremely busy and so any thank-you gifts we offer staff are simply that, a thank-you for an hour or two of their time.”

CSC has made no comment.

Pulse reports that the GP Systems of Choice framework agreement prohibits software providers from offering gifts to any servant of the authority or a PCT. The ban does not include GPs because they do not sign the framework. Suppliers can offer gifts to GPs without breaching the framework agreement says Pulse.

It quotes Dr Charlie Stuart-Buttle, a former chair of the EMIS user group and a GP in Tonbridge, Kent, as saying the incentives were an unacceptable way of going about things. It also quotes Dr Trefor Roscoe, a GP in Sheffield and former medical IT consultant, as saying the incentives were not a problem as long as the GPs felt the system in question was worth demonstrating in the first place.

Comment

Some will say that GPs are bombarded with offers of freebies from drug companies. So why does it matter if an IT company offers gifts?

Another argument is that drugs are different. GPs can stop offering drugs that become too expensive. They cannot simply stop using a GP system. It’s a big decision for any GP practice to choose a new system even with subsidies from the Department of Health under GP Systems of Choice GPs, while the GPSoC framework lasts. Any new GP system is likely to be a long-term commitment because of the disruption of changing.

GPs should surely choose their IT supplier on the basis of the facts and after shortlisting suppliers.

We dislike the expression “level playing field” but if applied here it would mean that GPs chose new systems only after demos at which all shortlisted suppliers offered tea at the Ritz or Marks and Spencer vouchers to certain GPs.

Alternatively the suppliers could agree that none offers gifts.

IT company’s tea at The Ritz offer to GPs.

Pulse article on TPP incentives

Are PCTs putting GPs under pressure to switch to SystmOne?

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Posted in change, Government IT, health, health records, managing outsourced services, NHS, npfit, outsourcing, Politics, procurement, supplier relationships

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Veterans Affairs lines up contractors for landmark health records IT project

Posted on 10/02/2012 | Leave a comment

By David Bicknell

A US IT project is being developed to provide  US military veterans with instant electronic access to their health and benefits information and other services.

According to Federal Times, the Veterans Affairs Department is now working with companies it already has on a $12 billion information technology contract to help it develop the Virtual Lifetime Electronic Health Record (VLER)

Last July, Veterans Affairs awarded 14 contractors, including CACI, Harris and Hewlett Packard Enterprise Services, a place on the department‘s Transformation Twenty-One Total Technology( T4) programme. The 15th and final spot is reported to have gone to SAIC.

Under the “five-year indefinite-delivery, indefinite-quantity task-order contracts”, vendors will provide program management and strategy planning, systems and software engineering, and other support.

The T4 contract has already been the subject of multiple bid protests – presumably because it appears so lucrative – including one filed last year Standard Communications in the U.S. Court of Federal Claims.

According to Federal Times, “nearly 39,000 US military veterans in 12 regions across the country — including Indianapolis, Richmond, and San Diego — have signed up to have their health information shared electronically among the Veterans Affairs, the US Department of Defence (DoD), and private health care providers.

“When participating veterans receive care, their physicians can request their laboratory results and other health data using the Nationwide Health Information Network (NwHIN), a project led by the Health and Human Services Department to provide a secure, standards-based method of sharing health information over the Internet. However, veterans must first agree to have their health information shared.”

The next project milestone for VLER will be this summer when Veterans Affairs and DoD decide how to expand health information exchange pilots nationwide.

Will the project succeed? It’s too early to say, although there are already some suggestions that the project has too many mouths to feed. One comment on the story so far argues that (the project) “has way too many contractors and staff involved. As we say, there are too many chiefs and not enough workers. It’s my bet that we will be talking about the 100 million dollar failure of the EMR at the expense of the US Taxpayers with in the year. They aren’t even getting the right type of people involved in the process. This is mainly a group of systems geeks and executives. They are leaving out the Health Information Management Professionals and the Medical providers…. it’s a boon doogle from the start, but at least the contractors are making money.”

Links

VA announces expansion of Virtual Life Electronic Record

10 Lessons Learned from Linking VLER to private health orgs

Veterans Affairs CIO on VLER progress

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Posted in Campaign4Change, health, health records, IT projects, managing change, procurement, project management

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