Tooning up Millennium

Last month, Newcastle Upon Tyne Hospitals NHS Foundation Trust went live with the Cerner Millennium system it contracted from University of Pittsburgh Medical Centre, outside the National Programme for IT in the NHS. Sarah Bruce visited the trust to see whether its gambit is paying off.

Arriving in Newcastle in dense fog after a delayed three hour journey from Kings Cross, it’s difficult to imagine being impressed by anything.

But a few hours into a tour of the Freeman Hospital, one of four city hospitals to go live with a brave ‘big bang’ implementation of Cerner Millennium on 7 November, it’s difficult to be anything but impressed by the electronic patient record system.

Since the go live, the trust has been rolling out the five electronic health applications it contracted University of Pittsburgh Medical Centre to deliver after rejecting offerings from former local service provider Accenture and current LSP CSC.

A new hospital for a new system

Newly recruited e-records programme director, Steve Leggetter, starts the whistle-stop tour on Ward 32, a 30-bed nephrology inpatient ward and part of the newly built renal services centre. It is the latest to be provided with Cerner’s clinical functionality and is also the first in the country to implement Cerner’s medicines management solution.

“People have bought into the system pretty well,” says Andrew Heed, lead pharmacist, e-prescribing. And pairs of nurses do seem to be working in complete confidence to bring up patient information on one of the six ward computers on wheels and read out the necessary medication before administering it to the patient.

Heed says: “The system is very specific about what time the medication is given and can track exactly who has done what on each ward. “We have a good group of clinical staff, a relatively stable patient group but a high volume of high complexity drugs, so everyone’s attitude is that if we can do it in Ward 32 we can do it anywhere in the hospital.”

The ward is still running paper processes for some of its patients, as not all of the trust has its functionality yet. “We’ll take paper away for drug prescribing when the whole of the Freeman has been rolled out fully, although items such as dietary products will continue to be on paper,” Heeds says.

“There will be a gradual roll-out until the end of the month and then that will be accelerated in January with a few wards a week until it is complete.”

One thousand five hundred and counting…

The trust now has more than 1,500 of its 12,000 staff using the Cerner system and just over 700 concurrent users; more than treble the number of users across the whole of the country for the LSP product, Lorenzo.

The trust has also reduced the number of UPMC and Cerner staff who were onsite on the day of the go-live from 40 to around ten. But with a project so big and the intention to eventually have almost 6,000 staff using the system, how easy is the training?

Leggetter tells me: “With something like this you need to make sure that individual wards can support themselves. So we have had super super users who are owned by the various directorates and [we’ve used] typical techniques [such as] train the trainers, meaning that Cerner and UPMC have trained the training team.”

The next demonstration of the system’s latest functionality comes on the lung ward, where manager John Davidson, explains electronic orders and results. He brings up task lists to show what is outstanding, takes a sample, prints out the labels for its tube and sends it off to the lab.

“Simple” he says. Alongside John is Thomas Webb, the e-records project manager, who has spent the last few weeks ‘floorwalking’ to make sure users are comfortable with the system. As such, he should know about any staff frustrations.

“When we went live, we had such a presence on the wards that there was never any mad rush where the phones were ringing off the hook,” he says. “Staff would just look round and we would be there.

“Although it was considered a big bang it was a staged roll-out across the trust, in that one area went live at 9am, we sat with them, made sure that staff were comfortable and then moved on to the next area a couple of hours later.”

According to Webb, the phone now only rings a couple of times a day and support will gradually be handed over to the help desk in the New Year. “It’s based on [Microsoft] Windows, so it’s similar to what people are used to in their everyday lives,” he says. “It’s right-click, left-click and not too many screens.”

From ward to lab-and back again

Down in the lab, where around 1,500 samples arrive per day, excitement around the system is overwhelming; perhaps because it is here that the system’s most obvious physical benefits can be seen.

Brian McArdle, the laboratory manager compares and contrasts the old and new ways of placing an order. As he begins checking a patient’s details against the blood sample and entering details on a screen, he asks me to follow the second hand on my watch.

He also shows me one completely illegible piece of writing, saying: “I can only understand that because I’ve been doing this for years.”

The process takes around one minute thirty seconds – and that’s before the sample has been analysed, the results put into a pigeon hole, taken to the relevant clinician and then manually signed off.

With the new Cerner system, it takes ten seconds for the sample to be scanned in. It’s then analysed and results are immediately inputted into the system, where they can be electronically signed off by the clinician.

Kevin Conway, director of IT in the international and commercial services division of UPMC, says: “There are so many areas where you can streamline and focus on patient care. “That’s one of the big benefits of the system – it allows staff to spend more time with patients. If you can get the clinical buy in then you win.”

Intensive activity in intensive care

Visits to see healthcare IT in action can easily turn into carefully orchestrated PR tours of hospitals. Not this one. Clinicians and nurses were free to talk about what they liked and disliked about the system, and did not need prompting to come up with examples of how they were reaping benefits for themselves.

In the Intensive Care Unit, where order communications have been running for a few days, results are being sent back in less than half the time it used to take, meaning that staff can change a patient’s treatment far more quickly.

Chris Straughan, a sister on the Critical Care Unit says: “When we can be doing full sets of blood for a patient every four hours, it is critical how quickly we can get those results back to make a patient more comfortable.”

But as the tour finishes, I have to ask Leggetter whether this roll-out has really been as smooth as it looks – and how Newcastle has managed to avoid the huge problems around 18-week reporting that trusts in London encountered when they deployed Millennium as part of the national programme.

“We anticipated that we needed to pay particular attention to the area and went in eyes wide open to that area of functionality,” says Leggetter.

“What’s happening here around 18 week reporting is that we understand the problems and the challenges and a lot of work went in with Cerner and UPMC and ourselves to make sure that the system lent itself to it. We are now in a situation where for the month of November the 18 week reports are due out.”

Royal Berkshire NHS Foundation Trust and Wirral University Teaching Hospital NHS Foundation Trust are also due to take Millennium outside the national programme. For them – and other trusts considering similar moves – Leggetter has one clear piece of advice.

“You have to have that vision at the top of the organisation. This has to be driven by the chief executive and the operating director and that’s just experience from anywhere and it’s just critical. The other part of the success story is that it has to be clinically led.”

Hear more: Sarah recorded a podcast with Steve Leggetter: clearing the fog.