Millennium delays creating financial risks, trust warns

A report by Worthing and Southlands Hospital NHS Trust on delayed plans to deploy Cerner Millennium warns that current reporting difficulties with the system "could have an impact on all remaining Cluster R0 go-live dates".

The trust board paper seen by EHI warns that should delays to the availability of a system that meets requirements continue, it will risk local financial turn around plans. Worthing and Southlands is attempting to turn around a £6m deficit in 2006.

The report states: “Confidence in the quality of the build and the ability to extract the necessary statutory and management reports from the system continues to be very low. Evidence that the build is fit for purpose and that information can be provided to support billing is essential for trust sign-off to go live.”

Testing of the Millennium system found that that approximately 17% of future appointments migrated were “out of slot” and deployment test scripts were 50% incomplete, resulting in witness testing being seriously delayed.

Detailing the reasons behind the trust not going live with R0 on its original go-live date, 2 November, John Taylor, director of IT at the trust lists a number of issues they found during testing prior to the proposed date.

Taylor notes that testing ‘has been significantly hampered as a result of lack of access to the system (unplanned down-times) and continued issues with the build’, meaning that training is now behind schedule and extra courses are now required, including “walk through” courses after go-live.

The IT director’s board paper warns that that continuing delays to the availability of the Millennium system create a risk to aspects of the trust’s financial turn around plans. “We cannot continue to allow the live date to just slip and slip due to impact on other activities within the trust, specifically on our financial turnaround project within outpatients. We are currently unable to amend templates to accommodate the savings planned by this project due to the data freeze required by the CRS project.”

David Sides, Cerner’s UK managing director told EHI: "The new system is based on modern architecture, offering greater stability and availability than anything clinicians have used previously. As with localisation to any specific trust, much is determined by the present technology environment and quality of the existing data."

Sides added: "We’re confident that we’ll work with the NHS and Worthing and Southlands Hospital to ensure that when the system goes live, clinicians will be able to operate it successfully and safely."

A telephone survey carried out this week by E-Health Insider of ten trusts in the South found there is now a growing backlog of trust’s waiting to receive a new deployment date from local service provider (LSP) Fujitsu, and Connecting for Health, to receive their new Cerner Patient Administration System (PAS). All the sites now queuing now appear to be waiting for the next two Millennium implementations, due to be in Milton Keynes and Winchester.

In November, Connecting for Health (CfH) said that ten trusts would receive new systems by the end of April this year but said deployment dates for nine trusts would be agreed only after a successful deployment into Milton Keynes, who had been due to go-live on 14 August 2006.

According to Fujitsu, Milton Keynes will be the first acute Cerner system to belong to a regional domain – shared systems across a specific geographic area or health community.

Mid and South Bucks deployed the first phase of their system in September in two of their hospitals, but a fortnight later Milton Keynes pulled out of joining the Buckinghamshire Shared Services domain citing ‘software errors’.

Milton Keynes this week told EHI that the initial problems cited – identified as ‘correcting software issues identified during testing; to ensure the accurate production of reports and to allow availability of NHS resources for training and testing’ have all been resolved to their satisfaction and that a green light has now been given to the board to set a go-live date. Trust staff were informed of the decision last Friday night and a target date has been set, which the trust declined to confirm to EHI.

A trust spokesperson told EHI: “Historically, there have been delays to allow final issues around data migration and reporting to be resolved. More recently there have been concerns about the performance of the live system which are now resolved and the project is currently ready to go live. The current delay is for a short period to allow sufficient time for the trusts already live on the domain to thoroughly test the software release that will be implemented as part of the process of Milton Keynes joining the domain.

The spokesperson added: “Whilst the Milton Keynes Project is awaiting ‘go live’ work is ongoing and the project board agrees it is best to go live at a time when everything is in place so we can ensure as smooth a transition as possible for our patients and staff.”

Only one trust contacted, Mid Hants in Winchester, has confirmed a go-live date to EHI, which it anticipates will be 10 February. Previous deployment dates were rescheduled to correct software problems identified during testing. They also needed to adjust the Cerner product to meet trust-specific requirements and to ensure the report can produce statutory reports.

A trust spokesperson told EHI: “Lessons learned have been shared from the other trusts who have gone live with R0 and key project team members have visited some of the other sites, however it would not be appropriate for our staff to ‘try’ the system at other trusts as they do not have a legitimate reason to do so.”

Many of the remaining eight trusts are in close localities to each other and will be part of similar ‘shared’ domains to Milton Keynes and several trusts have told EHI that they are waiting for trusts close to them to go-live before they do, and have informed staff of any developments in the CfH Care Records Service (CRS) programme.

A spokesperson from South Devon said that they were not planning on going live until the neighbouring North Devon trust has the system deployed and they are sure they are ready to co-ordinate clinical build and any necessary data migration.

In a statement, Fujitsu’s managing director of the public sector, Peter Hutchinson, confirmed to EHI that they have “further developed the software”, since initial implementations. He added that reporting had been the biggest reported problem with the system, but a lot of work has since been done and deployments will restart as soon as possible.

“Subsequent implementations show progressive improvements but trusts have experienced difficulties in completing reporting. This is caused by a combination of data migration issues from old systems, user adherence to defined processes for dataset input, training and the flexibility that exists within the Cerner system enabling shortcuts to be taken.

Hutchinson added: “Improvements have now been made to the process to build the local version of the new system; to make technology and process changes to increase the discipline enforced by the system; and to improve data quality during data migration. Future deployments will be re-planned to reflect the learning to date.”

Feedback from the trusts EHI has contacted indicates that trusts in the South have accepted that delays are inevitable, due to the need for the Release Zero system to be further developed.

Richard Smale, head of information services at Bath told EHI: “As expected with a programme the size of the NHS Care Records Service, it is not unusual that timescales will shift and change. A number of R0 trusts, including the RUH (Bath Royal United Hospitals) have experienced delays in anticipated go-live dates for the NHS Care Records Service, Cerner Millennium.

“Whilst any delay is regrettable, it is essential that the outstanding technical issues with Millennium are resolved and that we can be confident that the system is robust to support safe patient care.”

Two weeks ago, Robert Alexander, director of finance and investment at the South East Strategic Health Authority gave a similar view to his board on the deployment delays saying they would not be deploying R0 until they were sure the reporting functionality was working well, as a result they are also delaying deploying PACS or a new RIS.

On Surrey and Sussex NHS Trust, Alexander said: “We are currently identifying how this can best be managed. For PAS (Cerner Millennium) we have four communities deploying the current release (R0), and due to go live in March, April or May. This is later than originally planned, while additional management reporting functionality has been developed, and new functionality, notably Choose and Book, has been signed off.

“Subject to the sign off of the additional functionality, the projects are well placed to go live. However the extension to project times scales has raised risks both of maintaining confidence and momentum, and of the need to repeat training previously completed.”

A spokesperson from Surrey and Sussex told EHI: “The local health community will only agree a “go-live date when it is absolutely certain that we are fully able to manage the transition in the smoothest way possible… We are in regular communication with colleagues in other local health communities where Release Zero has already gone live. We are regularly evaluating [the] feedback from other health communities and are benefiting from the shared learning.”

In his report to the SHA board, Alexander said: “All other organisations in NHS South East Coast, except for the Ambulance Trust, are scheduled to take the next release – R1.”

EHI understands that Cerner Millennium Release One is due to be launched in March, which will include fixes to all reported problems and deliver additional benefits including order communications, however none of the ten trusts contacted said they would be waiting for this release.

It is anticipated that trusts not named in CfH’s deployment schedule to 30 April, will be offered Release One.

Fujitsu originally told the Commons Public Accounts Committee that Release Zero systems would be deployed at these trusts by the end of October 2006. Only three trusts currently have a Millennium Care Records System – Weston, Nuffield Orthopedic and Mid & South Bucks.

Release Zero is based on the version of Millennium was first installed Newham and Homerton in London, then piloted as an NPfIT system in the South at Nuffield, in December 2005.

In a November CfH statement, Hutchinson said: “We have further developed the software, as provided by Cerner, initially implemented at short notice into the Nuffield Orthopaedic Centre to take account of that experience and of new NHS requirements.”

Cerner was Fujitsu’s chosen replacement system for the IDX Carecast product it was initially going to deliver in the South. BT also switched to the Millennium system in November 2006, with implementations currently planned in the capital from summer 2007.