Category Archives: NHS

DWP starts media campaign on Universal Credit IT tomorrow

Posted on 19/09/2012 | Leave a comment

By Tony Collins

The Work and Pensions Secretary Iain Duncan Smith has told MPs his department is launching a “major exercise” tomorrow to inform the media about Universal Credit, including progress with the IT project.

The public relations push will include a demonstration to journalists of the Univeral Credit front-end, and an explanation of the ability of “agile” to rectify problems as you go along. Duncan Smith said there is a lot of ignorance in the media, and suppositions, that need tackling head on.

His full statement on the PR campaign is at the foot of this article.

Comment

Iain Duncan Smith’s remarks to MPs sound remarkably like the statements that were made in the early part of the National Programme for IT in the NHS, when DH ministers and senior officials were anxious to correct ignorance and suppositions in the media – and to show journalists the front end of new electronic patient record systems.

Several times journalists were invited to Richmond house in Whitehall, the HQ of the DH, to hear how well the NPfIT was going. So anxious were the minister and leading officials to give a good impression of the programme that, on one occasion, trade journalists who had an insight into the NPfIT’s progress and could ask some awkward questions in front of the general media were barred from attending.

I would like Universal Credit to succeed. In concept it simplifies the excessively complex and costly benefit system. The worrying thing about the scheme, apart from the DWP’s overly sensitive reactions to scepticism in the media, is the way UC seems to be following the path which led to NPfIT’s downfall.

The Secretary of State attacks the media while trying to show UC in a glowing light and at the same time keeps secret all the DWP’s interview reviews and reports on actual progress. Duncan Smith says that the DWP wants to be open on UC but his department is turning down FOI requests.

There is no doubt that Duncan Smith has a conviction that the programme is on course, on budget, and will deliver successfully. But there still a morass of uncertainty for the DWP to contend with, and lessons to be learnt from pilots, some of which could be important enough to require a fundamental re-think. That’s to say nothing of HMRC’s Real-Time Information project which is part of UC.

Duncan Smith says the UC project is not due to be complete until 2017 which gives the DWP ample time to get it right. But ministers and officials in the last administration gave the NPfIT 10 years to complete; and today, nine years later, the scheme is being officially dismantled.

Did NPfIT ministers really know or understand the extent of the project’s true complexities and uncertainties?  Did they fully grasp the limited ability of suppliers to deliver, or the willingness of the NHS to change?  But they were impressed with the patient record front-end system and they organised several Parliamentary events to demonstrate it to MPs.

The NPfIT public relations exercises – which included DH-sponsored DVDs and a board game to market the NPfIT – were all in the end pointless.

Should Duncan Smith be running Universal Credit?

This is another concern. Duncan Smith is much respected and admired in Parliament but he appears too close to UC to be an objective leader. At a hearing of the Work and Pensions this week Duncan Smith took mild criticism of UC as if it were a verbal attack on his child.

It is doubtful anyone working for Duncan Smith would dare give him bad news on UC , though he attends lots of departmental meetings. Doubtless he listens to all those who agree with him, those who are walking press releases on the progress of the UC programme. He’d be a good marketing/PR man on UC. But surely not its leader. Not the one making the most important decisions. For that you would need somebody who’s free from the politics, who is independently minded, and who welcomes informed criticism.

Is there any point in a demo of front-end systems?

Seeing a front-end system means little or nothing. The question is will it work in practice when it is scaled up, when exceptions come to light, and when large numbers of people try to contact the helpdesks because they cannot get to grips with the technology and the interfaces,  or have particular difficulties with their claim.

What will a media campaign achieve?

If the NPfIT experiences are anything to go by, journalists who criticise the UC project will be made to feel stupid or uninformed.

In a totalitarian regime the media could be forced to publish what the government wants people to believe. Will the DWP’s PR campaign be designed to achieve the same end without the slightest attempt at coercion?

Duncan Smith’s comments to MPs

Below is some of what Iain Duncan Smith told Work and Pensions Committee MPs this week. He had been asked by a Committee MP to have a dialogue with the media to ensure that people believe that Universal Credit is a good thing.

Duncan Smith:

“On Thursday we are carrying out a major exercise in informing the median about what we are doing, looking at the system front-end, about budgets and all the elements the committee has been inquiring into.

“We will take them through that, show them that. We are going to open up much more. It is such an important system that I want people to learn what it is all about.  There is a lot of ignorance in the media and suppositions made; things that are important to tackle head on. Everyone says you mustn’t have a big bang; you are not going to be ready in time. The time we deliver this is 2017 when it is complete.  That is over four years…”

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Posted in Agile, Campaign4Change, change, change management, culture, DWP, e-health, excessive secrecy, FOI, Government IT, IT projects, managing change, managing outsourced services, NHS, npfit, Politics, procurement, project management, public sector, public services, Real-Time Information, Universal Credit

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Would e-prescription system have saved this patient?

Posted on 14/09/2012 | 3 comments

By Tony Collins

The Portsmouth News reported yesterday that 77 year-old Joan Dixon died on Ashling ward at St Richard’s Hospital in Chichester after a large overdose of heart medication.

Had the proposed dose of medication gone through an e-prescription system would it have sounded an alarm before such an inappropriately large individual dose could be administered?

The Portsmouth News reported that a week-long inquest heard how junior doctor Prashen Pillay prescribed Joan Dixon with Digoxin for an irregular heartbeat.

Dr Pillay had meant to prescribe 250 micrograms of the heart-slowing drug, but instead wrote mg for milligrams.

Dr Pillay, who had been working at the hospital for about eight weeks, said: ‘Somewhere between my brain and my right hand it got turned from micrograms into milligrams.’

Woman died after prescription mistake.

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Posted in health, NHS

CSC signs NHS agreement with UK government – finally

Posted on 04/09/2012 | 1 comment

By Tony Collins

Four-year deal to deliver Lorenzo and other healthcare products

CSC announced today that it entered into an agreement with the NHS on August 31, 2012 to amend the existing contract under which CSC has developed and is deploying an integrated electronic patient records system using CSC’s Lorenzo Regional Care software products.

CSC says the agreement has received the approval of all required UK Government officials and is effective immediately. It offers “substantial flexibility to NHS trusts in their choice of electronic care records solutions while affording CSC the opportunity to expand and accelerate its marketing of the Lorenzo solution to NHS trusts across England”.

The term of the agreement extends through July 2016. It includes full mutual releases of all claims between the parties through the date of the agreement.

Under the deal the NHS will not be subject to minimum volume commitments which were part of the original NPfIT local service provider contracts. These controversial clauses had committed the Department of Health to a minimum spend with CSC, and could have led to the DH paying for deployments of Lorenzo that did not actually happen.

In return for this concession CSC has agreed to non-exclusive deployment rights in its designated regions. Trusts will receive ongoing managed services from CSC for a period of five years from the date of Lorenzo deployment by a trust, provided deployment is complete or substantially complete by July 2016.

“This agreement is a significant milestone in our relationship with the National Health Service and represents a renewed commitment by the NHS and CSC to a long-term partnership as well as CSC’s healthcare solutions,” said Mike Lawrie, CSC’s president and chief executive officer.

“Under this agreement CSC will continue to have the opportunity to support the NHS Information and Communications Technology infrastructure through deployment of our groundbreaking Lorenzo base product solutions, now rigorously tested and approved for wide-scale deployment across NHS.

“We are already seeing strong demand from NHS trusts that are confident our solutions will bring the safety and efficiency gains required by a modern NHS.”

Under the agreement the parties have redefined the scope of the Lorenzo products and have established deployment and ongoing service pricing.

CSC will deliver additional Lorenzo implementations “based on demand from individual NHS trusts”. The supplier says that a flexible arrangement has been established for these trusts to combine additional clinical modules with the core care management functionality of the Lorenzo solution to meet their specific requirements.

CSC and the NHS have also agreed to a streamlined approach for trusts which wish to take the Lorenzo products within the NHS-designated North, Midlands and East regions of England to obtain central funding from the DH for implementation of the Lorenzo products.

CSC may offer the Lorenzo solutions throughout the rest of England where trusts select CSC’s solutions through a separate competitive process.

It will offer a range of other solutions and services to the NHS, including general practitioner, ambulance and community systems, digital imaging and other related services.

CSC has told the US regulator the SEC that the new agreement “forms the basis on which the parties will subsequently finalize a full restatement of the contract”.

CSC gets £68m settlement up to 31 August 2012

The DH will pay CSC £68m, which represents what CSC says is “payment for value delivered to date, a net settlement amount for mutual claims of the parties and removal of exclusivity to provide a flexible market driven approach”.

But what the costs will be of continuing the NPfIT contracts, albeit modified, are not stated.

Comment

On the face of it the deal seems a reasonable one, though no figures are given. The big concession from CSC is the release of the NPfIT minimum volume commitments. It means the DH is not tied to minimum payments to CSC, whatever is deployed.

One question remaining though is whether trusts that have indicated they will take Lorenzo will be contractually committed to taking it. There’s a big difference between an intention to deploy and signing a contract to deploy it. Has the government made a promise to CSC to deploy Lorenzo at those trusts that have indicated a willingness to deploy it?

The DH says the new deal with CSC will save £1bn. CSC’s NPfIT contracts were worth £2.9bn. Much of that was unspent by August 2012. Does this new deal mean that CSC’s NPfIT contracts could still be worth about £1.9bn over 10 years, to 2015/16?

Open government requires that the DH release the terms of the deal, especially given the NPfIT’s disastrous history. But will that happen? Is the NPfIT being “dismantled” as the DH said it would be – or does this new deal with CSC keep it alive?

Is NPfIT being dismantled – brick by brick?

CSC gets £68m settlement

DH statement

The DH says that savings of over £1bn will be reinvested into the NHS following its “legally binding agreement with CSC”.

The DH press release says that the agreement will give local hospitals and NHS organisations the power to make their own decisions about which IT systems they use.

“The money saved will go back into the NHS and would be enough to pay for half a million extra knee and hip operations, and almost 15,000 extra doctors”.

The DH says it is committed to dismantling the National Programme for IT.

“The Department of Health, the local NHS and Cabinet Office have been in negotiations with CSC to ensure the existing Electronic Patient Record system, known as Lorenzo, is fit for purpose and focuses on the NHS’s current needs as well as providing value for money.

“Under the new agreement, CSC’s exclusive rights to be the only provider of clinical IT systems in the North, Midlands and East of England have been removed.

“The Government has been renegotiating its major contracts to not only ensure  wasteful spending is eradicated but that major suppliers are offering the best value for money.”

Health Minister, Simon Burns said  “We’ve removed the restrictive, top-down, centralised approach and given the local NHS the power to make their own decisions about which IT systems they use.

“The modern NHS still needs healthcare IT systems to exchange information securely and meet the needs of their patients. By re-shaping this contract, delays will be avoided in delivering much needed IT systems to the NHS, and will ensure the investment made to date is not wasted.

“This agreement marks a step in the right direction and a move to a new way of working which will allow the NHS to secure value for money and tailor its IT systems to meet the needs of its local patients.”

Minister for the Cabinet Office Francis Maude said

“Since May 2010 we have been building a strong operations centre at the heart of Whitehall to ensure that Government runs more like the best businesses.  As part of this we have been negotiating with our major suppliers, acting as a true ‘single client’, and generating savings of £806m and £437m respectively in the first two years of this Parliament alone.

“As I emphasised when I met with 20 of our top suppliers just last month, ours is not a Government that will tolerate poor performance – and today’s announcement will leave suppliers in no doubt that we will act to strip out waste from contracts where they offer poor value for the taxpayer.”

The Dh says that local NHS organisations “will no longer be committed to using Lorenzo, and will have the freedom to decide what IT systems are most suitable for their needs”.

CSC will retain responsibility for rolling out Lorenzo which is being used by 10 NHS organisations in the North, Midlands and East of England.

The DH says that if eligible local NHS organisations wish to use Lorenzo they will be able to access centralised support and funding but will first need to develop a robust business case and demonstrate value for money in order to gain approval to do so.

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Posted in CSC, e-health, health, health records, IT-related failures, NHS, openness and transparency, procurement, project management

Well done Eric Pickles – more open government to engulf councils

Posted on 29/08/2012 | 2 comments

By Tony Collins

Few people have noticed but changes to the law next month could force councils to be much more open about big spending decisions including those that involve contracting out IT and other services.

It is a pity though that similar changes will not apply to the NHS.

The Local Government Association says that councils are already more open than Whitehall which is true.

Even so some councils are innately secretive about IT-related spending decisions, and discussions about projects that go wrong. Somerset County Council was notoriously secretive about its Southwest One joint venture with IBM in 2007. The deal has not made the expected savings and has consistently made losses. IBM claims the deal is a success.

Haringey Council’s “Tech refresh” project which went way over budget is another example. Evasive answers to opposition questions and meetings in secret were the norm.

Liverpool City Council was extraordinarily defensive and secretive about progress or otherwise on its Liverpool Direct Ltd joint venture with BT. The deal included giving BT control of IT.

Better public scrutiny

Now Local Government Secretary Eric Pickles has announced that changes to the law will mean that all decisions including those affecting budgets and local services will have to be taken in an open and public forum.

Ministers have put new regulations before Parliament that would come into force next month to extend the rights of people to attend all meetings of a council’s executive, its committees and subcommittees.

Pickles says the changes will result in greater public scrutiny. “The existing media definition will be broadened to cover organisations that provide internet news thereby opening up councils to local online news outlets. Individual councillors will also have stronger rights to scrutinise the actions of their council.

“Any executive decision that would result in the council incurring new spending or savings significantly affecting its budget or where it would affect the communities of two or more council wards will have to be taken in a more transparent way as a result.”

Councils will no longer be able to cite political advice as justification for closing a meeting to the public and press. Any intentional obstruction or refusal to supply certain documents could result in a fine for the individual concerned.

The changes clarify the limited circumstances where meetings can be closed, for example, where it is likely that a public meeting would result in the disclosure of confidential information. Where a meeting is due to be closed to the public, the council must now justify why that meeting is to be closed and give 28 days notice of such decision.

Chris Taggart, of OpenlyLocal.com, which has long championed the need to open council business up to public scrutiny, said

“In a world where hi-definition video cameras are under £100 and hyperlocal bloggers are doing some of the best council reporting in the country, it is crazy that councils are prohibiting members of the public from videoing, tweeting and live-blogging their meetings.”

These are the changes to be made by the  The Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012 (the 2012 Regulations) which will come into force on 10 September 2012.

– Local authorities will have to provide reasonable facilities for members of the public to report council proceedings (regulation 4). This will make it easier for new ‘social media’ reporting of council executive meetings, opening proceedings to blogging, tweeting and hyper-local news/forum reporting.

– In the past council executives could hold meetings in private without giving public notice. From 10 September 2010 councils must give 28 days notice where a meeting is to be held in private, during which time people may make representations on why the meeting should be held in public. When the council wants to over-ride the notice period, it must publish a notice as soon as reasonably practicable explaining why the meeting is urgent and cannot be deferred (regulation 5).

– A document explaining the key decision to be made, the matter in respect of which a decision would be made, the documents to be considered before the decision is made, and the procedures for requesting details of those documents, has to be published (regulations 9).

– The new regulations create a presumption that all meetings of the executive, its committees and subcommittees are to be held in public (regulation 3) unless a narrowly-defined legal exception applies.

– Where the council has a document that contains materials relating to a business to be discussed at a public meeting, members of the local authority have additional rights to inspect such a document at least five days before the meeting (regulation 16). Previously no timescale existed.

– Where the council decides not to release the whole or part of a document to a member of an overview and scrutiny committee as requested by a councillor, it must provide a written statement to explain the reasons for not releasing such document (regulation 17).

– Documents relating to a key decision including background papers must be on the relevant local authority’s website (regulations 5, 6, 7, 9, 10, 14, 15, and 21).

Comment

Well done to Eric Pickles and the coalition. These are important and welcome changes. If council decision-makers know their discussions will be open to scrutiny they may give proper consideration to risks as well as the potential benefits of big IT-related investments. With inadequate scrutiny the potential benefits often drive decisions, which was the case with the flawed setting up of Southwest One. The press office at Liverpool City Council was so used to controlling information that its spokesman was outraged at questions we asked about its outsourcing venture with BT.

But what about the NHS?

It’s a pity the NHS is not subject to the new legal changes. Few trusts are open about their big IT-related investments; and when things go wrong, as has happened with some Cerner implementations, NHS trusts tend to lock all the doors, talk in whispers and instruct their press offices to issue statements that claim “teething troubles” have been largely addressed. The trust and everyone reading the statement know it is disingenuous but the facts to prove it are kept under wraps.

Organisations such as Imperial College Healthcare NHS Trust are taking decisions about major IT upgrades that could affect the safety, health and lives of patients without proper scrutiny. Pickles may want to mention his legal innovations to Andrew Lansley.

Eric Pickles announcement on opening up council discussions and decisions 

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Posted in BT Health, Campaign4Change, Cerner, decision-making, e-health, excessive secrecy, health, health records, improving communications, IT-related failures, local government, managing outsourced services, NHS, npfit, openness and transparency, operational issues, outsourcing, Politics, public sector, public services, public-private partnerships, shared services

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Could CSC use 200 jobs as lever in NPfIT talks?

Posted on 15/08/2012 | Leave a comment

By Tony Collins

In a blog post on ComputerworldUK.com I have asked whether CSC could use 200 UK jobs as a lever in its talks with the Department of Health and the Cabinet Office on a new NPfIT deal (towards end of the blog post).

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Posted in CSC, e-health, Government IT, health, health records, IT-related failures, Major Projects Authority, NHS, npfit

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Will coalition sign a new NPfIT deal with CSC?

Posted on 14/08/2012 | 1 comment

By Tony Collins

CSC has told investors that its discussions with the UK government on an interim agreement for deploying Lorenzo to the NHS are “continuing positively”.

CSC says that an agreement could commit a certain number of NHS trusts to take Lorenzo. Some of those trusts would be named in the interim agreement and the remainder within six months. CSC refers to them as “committed named trusts”.

[Such a legal commitment for named NHS trusts to take Lorenzo may run counter to the post-NPfIT coalition philosophy of giving trusts the freedom to buy what they want, when they want, and from whom they want. The named trusts might have indicated on a  DH questionnaire a wish to take Lorenzo but an agreement between the government and CSC would commit the trusts irrevocably, or the DH could have to pay CSC compensation for non-deployment.]

CSC says the deployed product would be categorized as “base product” or “additional product” for pricing purposes. The DH would commit money to the base product. Other funds would be available centrally available for “additional products,  supplemental trust activity and local configuration”.

The DH would give CSC a structured set of payments following certain product deliveries, as well as additional payments to cover various deployments for the named trusts and payments for work already performed.

If the government does not sign a new deal, and allows CSC’s existing contracts to run down until they expire formally in 2015, this could keep further NPfIT-related costs to the taxpayer to a minimum.  But it risks legal action from CSC, which says the NHS contract is enforceable and that the NHS has no existing right to terminate the contract, unless for convenience (which is unlikely).

If the government had terminated CSC’s contracts for its convenience (as opposed to alleged breach of contract) it would have had to pay CSC a termination fee capped at £329m as of 29 June 2012. CSC would also have been entitled to compensation for the profit it would have earned for the 12 months after the contract was terminated.

If the contract is not terminated, a new deal not signed, and no legal action is taken by either side, the amounts the UK government would have to pay CSC are likely to be minimised.  It is in CSC’s interests to maintain and enhance Lorenzo for those NHS sites that have deployed it.

So will the government sign a new deal with CSC at least to reduce the risks of CSC legal action? Or could the government hold out not signing any agreement until expiry of the contracts in 2015 on the basis that CSC has not delivered all it promised?

If a new deal is signed – and CSC indicates that an agreement is likely – the government may face accusations that it has broken its undertaking to dismantle the NPfIT.

David Camerson intervened personally to have the Cabinet Office’s Major Projects Authority look closely at NPfIT commitments.  His “efficiency” minister Francis Maude is likely to resist the signing of any new agreement

But will CSC accept the government’s refusal to sign a new deal, when such a deal could enable CSC to recover at least some of the $1.485bn (£0.95bn) it recorded as an NPfIT contract charge in the third quarter of 2012?

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Posted in CSC, e-health, Government IT, health, health records, NHS, npfit, supplier relationships

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Cerner US-wide outage – what went wrong?

Posted on 10/08/2012 | Leave a comment

By Tony Collins

Hospital EMR and EHR has an account of what caused Cerner’s outage which affected its client sites across the USA and some international customers, according to reports.

It makes the point that the problem had little or nothing to do with the cloud.

The Los Angeles Times reports that within minutes of the outage, doctors and nurses reverted to writing orders and notes by hand, but in many cases they no longer had access to previous patient information saved remotely with Cerner.

“That information isn’t typically put on paper charts when records are kept electronically,” said the newspaper which quoted Dr. Brent Haberman, a pediatric pulmonologist in Memphis as saying, “If you can’t get to all the patient notes and all the previous data, you can imagine it’s very confusing and mistakes could be made…A new doctor comes on shift and doesn’t have access to what happened the past few hours or days.”

Hospital EMR and EHR

Some hospitals cope well through the outage

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Posted in Cerner, Disaster recovery, health, health records, IT-related failures, NHS, npfit

Some lessons from a major outage

Posted on 31/07/2012 | 2 comments

By Tony Collins

One of the main reasons for remote hosting is that you don’t have to worry about security and up-time is guaranteed. Support is 24x7x365. State-of-the-art data centres offer predictable, affordable, monthly charges.

In the UK more hospitals are opting for remote hosting of business-critical systems. Royal Berkshire NHS Foundation Trust and Homerton University Hospital NHS Foundation Trust are among those taking remote hosting from Cerner, their main systems supplier.

More trusts are expected to do the same, for good reasons: remote hosting from Cerner will give Royal Berkshire a single point of contact to deal with on technical problems without the risks and delay of ascertaining whether the cause is hardware, third party software or application related.

But what when the network goes down – across the country and possibly internationally?

With remote hosting of business-critical systems becoming more widespread it’s worth looking at some of the implications of a major outage.

A failure at CSC’s Maidstone data centre in 2006 was compounded by problems with its recovery data centre in Royal Tunbridge Wells. Knock-on effects extended to information services in the North and West Midlands. The outage affected 80 trusts that were moving to CSC’s implementation of Lorenzo under the NPfIT.

An investigation later found that CSC had been over-optimistic when it informed NHS Connecting for Health that the situation was under control. Chris Johnson, a professor of computing science at Glasgow University, has written an excellent case study on what happened and how the failure knocked out primary and secondary levels of protection. What occured was a sequence of events nobody had predicted.

Cerner outage

Last week Cerner had a major outage across the US. Its international customers might also have been affected.

InformationWeek Healthcare reported that Cerner’s remote hosting service went down for about six hours on Monday, 23 July. It hit “hospital and physician practice clients all over the country”. Information Week said the unusual outage “reportedly took down the vendor’s entire network” and raised “new questions about the reliability of cloud-based hosting services”.

A Cerner spokesperson Kelli Christman told Information Week,

“Cerner’s remote-hosted clients experienced unscheduled downtime this week. Our clients all have downtime procedures in place to ensure patient safety. The issue has been resolved and clients are back up and running. A human error caused the outage. As a result, we are reviewing our training protocol and documented work instructions for any improvements that can be made.”

Christman did not respond to a question about how many Cerner clients were affected. HIStalk, a popular health IT blog, reported that hospital staff resorted to paper but it is unclear whether they would have had access to the most recent information on patients.

One Tweet by @UhVeeNesh said “Thank you Cerner for being down all day. Just how I like to start my week…with the computer system crashing for all of NorCal.”

Another by @wsnewcomb said “We have not charted any pts [patients] today. Not acceptable from a health care leader.”

Cerner Corp tweeted “Our apologies for the inconvenience today. The downtime should be resolved at this point.”

One HIStalk reader praised Cerner communications. Another didn’t:

“Communication was an issue during the downtime as Cerner’s support sites was down as well. Cerner unable to give an ETA on when systems would be back up. Some sites were given word of possible times, but other sites were left in the dark with no direction. Some sites only knew they were back up when staff started logging back into systems.

“Issue appears to have something to do with DNS entries being deleted across RHO network and possible Active Directory corruption. Outage was across all North America clients as well as some international clients.”

Colleen Becket, chairman and co-CEO of Vurbia Technologies, a cloud computing consultancy, told InformationWeek Healthcare that NCH Healthcare System, which includes two Tampa hospitals, had no access to its Cerner system for six hours. The outage affected the facilities and NCH’s ambulatory-care sites.

Lessons?

A HIStalk reader said Cerner has two electronic back-up options for remote hosted clients. Read-only access would have required the user to be able to log into Cerner’s systems, which wouldn’t have been possible with the DNS servers out of action last week.

Another downtime service downloads patient information to local computers, perhaps at least one on each floor, at regularly scheduled intervals, updated say every five minutes. “That way, even if all connection with [Cerner’s data centre] is lost, staff have information (including meds, labs and more) locally on each floor which is accurate up to the time of the last update”.

Finally, says the HIStalk commentator, “since this outage was due to a DNS problem, anyone logged into the system at the time it went down was able to stay logged in. This allowed many floors to continue to access the production system even while most of the terminals couldn’t connect.”

But could the NHS afford a remote hosted service, and a host of on-site back-up systems?

Common factors in health IT implementation failures

In its discussion on the Cerner outage, HIStalk put its finger on the common causes of hospital IT implementation failures. It says the main problems are usually:

– a lack of customer technical and implementation resources;
– poorly developed, self-deceiving project budgets that don’t support enough headcount, training, and hardware to get the job done right;
– letting IT run the project without getting users properly involved
– unreasonable and inflexible timelines as everybody wants to see something light quickly up after spending millions; and
– expecting that just implementing new software means clearing away all the bad decisions (and indecisions) of the past and forcing a fresh corporate agenda on users and physicians, with the suppplier being the convenient whipping boy for any complaints about ambitious and sometimes oppressive changes that the culture just can’t support.

Cerner hosting outage raises concerns

HIStalk on Cerner outage

Case study on CSC data centre crash in 2006

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Posted in Cerner, Disaster recovery, e-health, health, health records, IT-related failures, NHS, npfit, public sector, public services, Remote Hosting, software quality, supplier relationships

Will health IT market “heat up” when NPfIT contracts expire?

Posted on 31/07/2012 | 1 comment

By Tony Collins

At a second-quarter earnings call, Marc Naughton, Chief Financial Officer at US-based health software supplier Cerner, singled out the UK as one country where there will be probably be “a lot of demand” for new health IT products and services subject to capital being available.

He said,

“As more and more of those trusts are becoming foundation trusts, which means they control their capital outlet – outlay as opposed to the government putting the dollars out there – we think that’s going to turn into a more normalised US-type market where each trust is going to go out to the market and look to acquire technology.

“In 2015, the current NHS [NPfIT] contracts expire. So almost all of those trusts are going to be looking in the market in some form or fashion, probably depending on their access to capital.

“So we think that market is one that could heat up in 12 to 18 months from now, assuming that they can get access to capital. But it is going to be a little bit lumpy.”

 

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Posted in Cerner, e-health, health records, NHS, npfit, procurement

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Trust buys extras-laden system for 20% of BT’s price

Posted on 30/07/2012 | Leave a comment

By Tony Collins

An NHS Trust has paid £1.8m for the “Rio” patient record system and a host of extras – which raises fresh questions about why the Department of Health paid BT £9m for each Rio deployment under the NPfIT.

BT’s deal with the Department of Health under the NPfIT costs taxpayers £224.3m for 25 deployments of Rio – about £9m for each one. The deal included support for five years, until October 2015.

But a deal struck directly between Cambridgeshire and Peterborough NHS Foundation Trust and Rio’s supplier CSE-Healthcare Systems includes support for a year longer – six years in total. At £1.806m the cost of Cambridgeshire and Peterborough’s deal is about 20% BT’s price.

Cambridgeshire and Peterborough has secured more extras. CSE-Healthcare Systems will supply Cambridgeshire and Peterborough with:

  – Medical software development services

– Software consultancy services

 – Computer support services

– System implementation planning services

– Software implementation services

– Project management consultancy services

– Business and management consultancy services

– Medical software package

– Database and operating software package

– Information systems and servers

– Computer and related services

– Software support services

It’s not clear though whether the deal includes disaster recovery – which the Department of Health argues is one reason for the price paid to BT for Rio.

Comment:

Disaster recovery does not explain how or why the Department of Health agreed to pay BT five times more for Rio than paid by Cambridgeshire and Peterborough.

What is not in doubt is that if BT, like Accenture and Fujitsu before it, had left the NPfIT, the programme would have been indelibly stamped a disaster – at a time when the Department of Health and ministers were proclaiming it an unacknowledged success (in the run up to a general election).

Was BT paid a hugely costly premium to stay in the NPfIT?  If so, should tax money have been used to secure the affections of a supplier whose profits were otherwise being squeezed on the contract?

Last year the Department of Health gave the Public Accounts Committee an explanation of its Rio payments to BT, some of which is below. The explanation is long, vague and defensive enough to sound like the excuses of a young boy who, when questioned by his teacher, gives various accounts of why he took a classmate’s sweets.

What the DH told MPs

This is what the DH told the Public Accounts Committee last year, after one of its MPs Richard Bacon queried the payments to BT for Rio (and Cerner).

“Assessing the value for money of the RiO prices was part of the CCN3 [change control note 3] negotiation process … The CCN3 negotiation process was lengthy and involved many iterations challenging the component parts of the BT cost model. This included ensuring that rates offered were competitive and that the effort ascribed to various activities was justifiable.

Taken together, competitive rates and reasonable effort comprise value for money. BT was required to provide numerous iterations of financial models. These models were reviewed in detail by the Authority, resulting in multi-million pound savings.

The Authority negotiated reduced day rates on all of the BT labour within the contract. In addition, BT’s profit margin on the contract was also significantly reduced. Other commitments were also obtained by the Authority, in particular around sub-contractor pricing; for example, Cerner has confirmed that the pricing provided to the Authority (via BT) is the best it provides to any of its customers.

The Authority then requested further financial assurances and agreed with BT that a requirement of signing CCN3 would be that a verification exercise would be conducted by third party, independent financial experts (KPMG)…

In October 2010 KPMG were requested by the Authority to verify the costs presented by BT, including those for RiO, in the CCN3 Financial Model.

The approach adopted by KPMG was as follows:

—  Their work focussed on the Cost Data sheet within the CCN3 Financial Model and was conducted on a sample basis, designed to provide a high coverage of costs with a reasonable sample size.

—  The cost elements for potential duplicate entries were reviewed.

—  The cost rates associated with BT labour were validated to cost rate cards and payroll records.

—  The hours presented in the Model associated with BT labour were reviewed for reasonableness.

—  Sub-contractor and other supplier costs were validated to the agreements entered into by BT with their suppliers.

—  Cost elements and supporting documentation requested from BT were sampled to substantiate the costs provided…

On 3 November 2010 KPMG concluded that “BT has provided underpinning evidence to support the agreed delivery costs” and that “no proposed adjustments are required for Agreed Delivery Costs”.

None of the trusts consulted had purchased the same RiO product offering and all trusts varied significantly from the offering provided to NPFIT trusts, making a direct price comparison difficult. However, trusts within the programme typically had significant advantages to those outside the programme, namely:

—  The ability to influence the functionality of the product.

—  Centrally provided and hosted hardware.

—  Centrally-provided disaster recovery with 100% capacity and availability.

—  No additional development costs for subsequent releases.

—  Spine connectivity.

BT estimate that the monthly charge for hardware, disaster recovery, service management and Spine connectivity to be in the region of £42,500 per month or just over £2 million of value over a 48 month contract term.

Furthermore the NPFIT investment in the development of the RiO has significantly enhanced the functionality of the product to the benefit of all trusts. Examples of functionality in the latest deployed version (v5) and soon to be deployed (R1, 2011) of RiO include:

—  Standard assessment forms.

—  Care-plans and reports.

—  Spine connectivity, enabling integration with central demographics services, and functionality to support smart cards and role based access controls.

—  Waiting lists.

—  Results reporting.

—  Prevention, screening and surveillance.

—  SNOMED.

—  Inpatient prescribing.

—  Functionality to support multi-disciplinary care planning.

DH statement to MPs on Rio (and Cerner) prices paid to BT

MP seeks inquiry into £546m NHS deal with BT.

Breakdown of £546m NPfIT payment to BT

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