Lengthy delivery for NPfIT maternity systems

The delivery of new maternity systems as part of the NHS IT programme has stalled, E-Health Insider has learned.

Not a single hospital has yet received a new system, and a leading obstetrician has warned that the delays are creating potential “clinical risks” to mothers and children.

The lengthy delays to maternity software are causing huge frustrations for NHS trusts that urgently need modern systems to meet the latest statutory reporting and child screening initiatives, and effectively manage their clinical litigation risks.

But the Evolution maternity software from iSoft, offered as a stopgap solution in 60% of England under the NHS National Programme for IT (NPfIT), is said to be out-of-date and requiring considerable development before it can be implemented.

An NPfIT-compliant version of Evolution that connects to the central NHS data spine was meant to have been provided as an ‘emergency bundle’ from the beginning of 2005 to hospitals across the north west and west midlands, north east and east of England. This had only been intended as an interim solution to meet urgent needs before maternity functionality was delivered by NPfIT as part of an integrated ‘strategic’ clinical systems suite.

But no hospitals have received any new maternity systems. The cumulative delays are said to be acting as a deadweight on the modernisation of maternity services, which had previously been considered leaders in using IT to deliver improved patient care.

The pilot site for the NPfIT version of Evolution, the Royal Shrewsbury Hospital NHS Trust, Shropshire, was meant to receive a maternity system from its local service provider Computer Sciences Corporation (CSC) to meet the urgent need in 2005. CSC this month told the trust that the software will now be available in autumn 2006.

“CSC have said they will have a product by the end of October, but based on past record we can’t have a lot of confidence in that,” said Dr Adam Gornall, consultant in foetal medicine and leader the maternity IT project at Shrewsbury and is the national lead for NPfIT’s ‘do once and share’ maternity programme.

He told E-Health Insider: "We are an early implementation site – the first for the national programme – and have been working with CSC and the cluster on evaluating Evolution which was the emergency bundle for maternity". Dr Gornall stressed he was committed to the success of the programme.

The trust, which currently has no maternity IT system at all, is crying out for a new system to help improve patient care and safety and meet stringent national requirements.

Trusts are currently under huge pressure to implement systems in line with the Clinical Negligence Scheme for Trusts (CNST).

"If we can move up the CNST we can reduce our clinical risk costs," explained Dr Gornell. "We’re currently at 2 but want to move up to 3 – and most of the level 3 requirements are about audit."

He told EHI that the NPfIT project had been running on and off for about 18 months: "There were a number of implementation dates. The initial ones were very naive… It slipped and slipped from early 2005." After a lengthy hiatus the project was restarted two months ago.

Dr Gornell said one source of a long delay had been the trust’s concerns about the version of the Evolution software first presented to them. "We weren’t very happy with the product they were offering, it hadn’t been updated for a number of years." He said work was need to being the software in line with national requirements including the antenatal assessment process recommended by NICE and to support neonatal blood screening.

Although encouraged that CSC were now working in a more hands on fashion with iSoft, he still had concerns about the product. “My concern is whether alterations of an old product can be made to the point it is clinically safe.”

The main problem was that Evolution was trying to re-engineer the way the software was designed to run. “There are difficulties in interfacing with the data centre.”

Having identified a series of fixes needed CSC took the product away to work on it with iSoft. "They are working on the product and going though a testing cycle," said Dr Gornell.

Dr Gornell acknowledged that Shrewsbury is under the microscope as the early adopter: "My trust and the executive and department are putting the trust implementation team under increasing pressure to have a system in place as soon as possible."

He added: "The pressure is on CSC and iSoft. They have to have an implementation site.” When EHI contacted CSC to ask when it would be implementing Evolution a spokesperson said the LSP was currently evaluating options for maternity. EHI understands that low demand for some of the key products it is offering the NHS is major concern within CSC.

Similar frustrations with Evolution also exist in the eastern and north east clusters where Accenture is the LSP and is also offering iSoft’s Evolution. A March Accenture document seen by EHI says of the software. "Demand for the offering to date has been low due to what some trusts perceive as shortcomings in the functionality."

A spokesperson for Accenture said that no sites in the North east of East had yet gone live with Evolution, but that it was working with two early adopter sites.

Dr Peter Brunskill, consultant in obstetrics and gynaecology at Airedale NHS Trust and ex-head of the Evolution user group said that the software has not been developed for several years and "no longer reflects the care we are expected to provide to patients". In some areas he said this "could be interpreted as a clinical risk."

He told EHI that the Evolution system was now badly out of date as updates from 2001 and 2002 that had been due to have been incorporated when Protos was bought in 2003 had never been implemented.

iSoft acquired Evolution when the firm bought rival Torex in 2004. Torex had acquired the software by buying developer Protos in 2003.

A spokesperson for iSoft rejected the suggestion that development work had ceased. The spokesperson told EHI that a Lorenzo maternity module would be introduced in 2008/2009.

Dr Brunskill said he was concerned that, as well as being unable to support the antenatal assessment process and neonatal bloodspot screening, Evolution was unable to electronically store infant heart monitoring records – known as CTGs (cardiotocography). "I think archiving of CTGs is absolutely essential. Other available systems electronically archive and automatically alert if there is a problem," said Dr Brunshill.

He said paper traces alone are insufficient as they are printed on heat sensitive paper and often fade. "From a risk point of view an asphyxiated brain dead baby is worth £3.5m. Sometimes we don’t win these cases as the trace can’t be read."

Dr Brunskill said that another limitation of the system was its inability to share records with community-based staff. He told EHI that if a trust had no maternity system at all then Evolution was still a "great leap forward", but said it offered no coherent development path. "Once you’ve leapt that’s it."

"I don’t see why we should have to rely on one obsolescent product which will never be spine compliant and is incapable of being developed to meet a range of mandatory requirements," said Dr Brunskill.

He told EHI that LSP Accenture currently have no design team working on a maternity product. "It’s Evolution or nothing." Accenture has yet to implement a single instance of Evolution.

Leicester University Hospitals NHS Trust, the largest maternity hospital in Europe, is one trust that has become fed up with waiting for a suitable maternity system. The trust which is in the eastern cluster of the NHS IT programme with Accenture is LSP has decided to buy one itself. The trust – which currently uses the Euroking maternity system – in May issued an OJEU tender for a new maternity system.

Two other hospital trusts have already voted with their feet, going outside the national programme and buying their own maternity IT system. One of them was Bradford NHS Trust, which last month signed a deal for a brand new maternity system called Eclipse provided by Huntleigh Healthcare.

The new system, which should go live by the end of the calendar year, will replace paper based maternity records currently in use at the trust.

Derek Tuffnell, a consultant obstetrician at the trust told EHI that the trusts needed the flexibility Eclipse offered for the new ‘Born in Bradford’ project that will follow the health of 10,000 mothers and their babies over the next decades.

He said that Evolution didn’t offer the capabilities needed as "it’s principally an intra partum [in labour] system".

"The main advantage of Eclipse is that it will also enable us to collect information in the period before and after birth."