Lessons learned

Joe Fernandez

In an exclusive briefing with E-Health Insider last week Fujitsu’s head of public sector Peter Hutchinson and chief medical officer, Lester Russell, said that there was a "tremendous amount" of deployment activity and work with trusts underway, with detailed planning occurring at 17 trusts.

Fujitsu’s biggest success to date has been the successful roll-out of the first stage of picture archiving and communications systems (PACS) across the south. Although six sites are now live with the Cerner Millennium patient administration system, experiences have been mixed ranging from very positive at Winchester to very vocal complaints at Milton Keynes.

With implementation plans now being revisited as part of the current local service provider contract ‘reset’, Fujitsu says the next site to go live is likely to be at Taunton, Somerset.

The trust had most recently been scheduled for 30 June, but was delayed "in order to allow time for remaining final issues to be resolved", Hutchinson told EHI. It is now scheduled for this autumn.

Fujitsu declined to comment on the ‘reset’ in the south. Fujitsu’s public sector boss Peter Hutchinson said “We don’t comment on commercial matters.”

Lessons learned from first six Millennium sites

Hutchinson stressed that many lessons have been learned from the first six Millennium sites. The key behind successful trust implementations, he said, was that they are led from the top. "The secret is to be led from the top. Where they delegate to the IT department it has been more of a problem.”

Hutchinson used Fujitsu’s most recent installation Surrey and Sussex, as a prime example of what could be achieved:: "Everyone thought Surrey and Sussex would be really tough, but the project was a success largely because it was led by the chief executive and head of nursing."

Hutchinson said: “Clinicians are getting keener and enthusiasm is growing. The problem is that different sites have different needs, some have a real sense of urgency and are led from the top with leadership, whilst others delegate the task to IT departments which doesn’t necessarily work.”

Past order comms issues ‘fixed’

Fujitsu’s public sector boss dismissed reports of problems with the order communications functionality provided in Millennium, saying past issues had been fixed and trusts were looking to switch the functionality on.

To date only Winchester and Eastleigh uses the functionality, with other NHS sites – including North Bristol and United Bristol – purchasing interim systems to do order comms of tests and results reporting.

“There is now more interest in order comms. We acknowledge that there were issues, but we are confident that R0 sites will be able to switch it on, and R1 sites will use it once the system is installed,” said Hutchinson.

‘Best of suite’ rather than best of breed

Hutchinson said Fujitsu was now beginning to look at additional products and offerings as part of the NHS IT programme, an early example being the recent deal with McKesson to supply its CarePlus child health system. A further announcement is expected soon on ambulance systems.

The Fujitsu boss confirmed that INPS is the LSPs chosen GP system, which it is working to integrate into Cerner Millennium. He said that this will be to the level 6 requirements of GPSoC. Hutchinson poured cold water on the idea that the LSP would make the significant investment required to get any other GP system supplier up to same level of accreditation.

Asked by EHI whether Fujitsu was now pursuing a comparable strategy to the best of breed approach being followed by BT in London, Hutchinson described Fujitsu’s approach as "best of suite".

He added: “Working on a large scale programme was always going to be difficult, but we are sure that the element of risk will lead to a mutually satisfactory outcome. We have already had success with PACS and if we can get more clinical champions like we have with that, then we can really start to make progress with our acute trusts.”

Securing clinician commitment

Dr Lester Russell, Fujitsu’s chief medical officer, told EHI: “Some clinicians do struggle to get it [the benefits of Millennium]. Attitudes towards Millennium are variable, but through successful implementations, some are starting to appreciate it now, but we must remember that GP practices went digital over a 10 year period, acute deployments are much more quick and complex – and to do it in a few years is quite a big ask."

Dr Russell said that for some clinicians the change involved was unsettling: “Clinicians find change quite threatening, but we have to be seen to be moving with the times. Some of it is frankly embarrassing, for example in the year 2007 it is not really acceptable for a person to object to a system because they don’t understand what SNOMED technology is and would prefer to work with the silos that are currently in place.”

Dr Russell says Fujitsu is working to address these types of issues through user support sessions and workshops with trusts who are shortly to go-live. “Clinicians must see the benefits. There is more work to do on this – some work still to do, and some being actively done."

He said that a key to getting clinician buy-in would be to provide them with more of the clinical functionality they wanted. He stressed that much was already contained within Millennium even though in many cases it was not being used yet. Winchester, for instance, is the only Millennium site in the South to yet use order communications.

Dr Russell told EHI: "In some trusts, there is a lot of functionality not being used, which has no value to them just waiting to be used. I believe that NLOP [National Programme for IT Local Ownership Programme] will get us to the point where local encouragement helps others to see the benefits the modules could bring.”

Translating NLOP into local enthusiasm

Hutchinson said that after a slow start NLOP is now really starting to gather momentum, with SHAs and trusts now much more involved. He declined however to give details of the contract ‘reset’ process now underway.

The Fujitsu public sector boss said that the Millennium could bring necessary changes to a hospital, helping make data more accurate and keeping patients safe. But in some cases there is a more basic fear of change.

“Millennium can bring fundamental change to a trust. Take the data environment most trusts work in for example, currently they just are not very accurate and there is a ‘We’ll tidy it up and get it right later’ attitude. With Millennium data can be easily retrieved in real-time from one place offering an accurate report on a patient quickly, helping to ensure a patient’s safety.”

Learning from its initial sites Fujitsu now works with trusts to configure the system to their requirements and phase data capture requirements.

Hutchinson said: “I understand why some clinicians say they don’t like it, but problems only tend to arise when there is a clash of interests as to what they are actually asking for.

Fundamentally, the problem is change and people simply don’t like it.

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