Barts underestimated impact of IT system

Barts and The London NHS Trust said today [1 September 2008] it had underestimated the impact of going live with a new system under the NHS's £12.7bn National Programme for IT [NPfIT].

Difficulties in scheduling patients for appointments have led to operating theatres and clinics being unused at times, despite high demand for them.

The trust is funding nearly £1m for extra temporary staff relating to the NPfIT go-live from its reserves. And it faces a further £1.5m shortfall in income because it may not be able to bill its local primary care trust for the patients it sees and treats.

A spokesman for Barts and The London NHS Trust told Computer Weekly an "intensive programme of measures is in place" which "will allow us to return to our previous performance levels as quickly as possible".

The trust has "apologised publicly to patients, GPs and staff for the difficulties they have experienced," he said.

The spokesman was responding to Computer Weekly's questions after the trust published board papers on its website describing "significant" ongoing problems after the implementation of the Care Records Service,

The trust has had difficulty maintaining an overview of which patients have been treated for what following roll-out of the system. It is paid according to the information it provides to the local primary care trust on the patients it sees and treats. But the trust warns in its latest board papers that income may be much less due to difficulties gathering accurate information on who has been seen for what and when.

A financial paper to the board on the first quarter of the trust's 2008/9 year says:
"There remain significant data quality issues with the Trust's activity and patient activity and income information due to the implementation of the Care Records Service.
"To reflect the high risk around income the trust has provided £1.5m against the first quarter's income."
The paper adds: "There are also known system errors where data which has been entered into CRS [the Cerner Care Records Service system] has not been reflected in the data warehouse and therefore is missing from SLAM [Service Level Agreement and Monitoring system]. These issues have caused [a] significant understatement of both inpatient and outpatient activity and income".

The trust says that BT and Cerner are "working on solutions to stop further errors". With fewer than expected patients being booked clinics and operating theatres have been under-used.
"There is some evidence that April activity was reduced due to the implementation issues of CRS. Clinics were reduced in some areas and issues with bookings meant that in some areas the clinics and operating theatres were not operating their usual capacity".

The trust has directed nearly £1m from central reserves nearly £1m to ICT to "fund additional temporary staff costs relating to the implementation and subsequent validation of CRS".
Bart's and the London Care Records System is based on a patient administration system from US supplier Cerner and BT, London's NPfIT local service provider.

Two other London trusts, Barnet and Chase Farm and the Royal Free Hampstead have also had significant and protracted problems after going live with the Cerner system. There have difficulties at go-lives of trusts outside London too. But the government and the Department of Health want trusts to accelerate plans for trusts to deploy NPfIT systems.

A spokesman for Barts and The London said: "The Trust anticipated that there would be a greater degree of fluctuation in activity levels in the period before and after the CRS [Care Records Service] go-live in April, but we underestimated the level of impact that CRS would have on our operations."

* - Article from Computer Weekly.

As a point of interest, i was at the Royal Free Hampstead only a few weeks ago as my Girlfriend unfortunately had to go into A & E and stay in Hospital for a few days. There was no obvious sign of the significant and protracted problems with the speed of the service or the treatment she received. However, there were signs everywhere explaining that the new system had been installed and that there may be some teething issues.

Good luck to them, sometimes change isn't easy but has to happen!!! If they need a hand with their recruitment of temporary ICT staff they could always contact us.