The Rotherham moves to best of breed

The Rotherham NHS Foundation Trust has issued a draft informatics strategy, in which it blames a failure to listen to clinicians’ views for its disastrous Meditech v6.0 implementation.

The trust is now going to adopt a “best of breed approach to its EPR”. The trust went live with Meditech v6.0 in June 2012, but has been plagued by issue after issue ever since.

The trust’s draft 2014-17 informatics strategy, presented to the board last week, says lack of clinical involvement was one of the main reasons.

“Clinical acceptance of the Meditech product has been fraught with difficulty, due to the nature of the implementation and because clinicians’ views and ideas were not reflected in the development and design of the product,” it says.

“Clinicians weren’t involved in the testing and so, at go-live, the full impact of EPR use on clinical efficiency and throughput added to the problems.

“Lack of clinical engagement during the implementation process has left a significant legacy of distrust and negativity towards ‘the product’ as opposed to ‘the vision’.”

The problems with the Meditech implementation led the trust to stop all further go-lives of EPR modules and functionality, and contributed to it being found in significant breach of the terms of its authorisation by foundation trust regulator Monitor late last year.

In May this year, the trust submitted an EPR recovery plan to the regulator. According to its informatics strategy, it has now decided to go for a “best of breed” approach to and downsize its use of Meditech.

“The reality of working with the Meditech product and the degree to which community services have changed the landscape makes us re-evaluate our approach,” says the strategy.

“There is a realisation that many departmental systems we have will remain and contribute to an integrated electronic record, wrapped in a clinical portal.

“A best of breed, fit for purpose approach within a skin or a portal capable of adding functionality is widely viewed as the best approach and one the trust should exploit.”

The Rotherham was one of the first trusts to go outside the National Programme for IT for an EPR project. It talked about making a bold move to save significant sums of money and improve care, in line with the ‘Nicholson Challenge’ for the NHS as a whole to save £20 billion by 2015.

It also planned a “big-bang” implementation that included live bed-management, A&E, order communications and a patient administration system.

However, shortly after go-live, the A&E department reverted to the old system, Ascribe’s Symphony, due to “significant operational issues”. It is still using the system today.

“Due to several significant issues, the service reverted to using the unsupported Ascribe Symphony system whilst a review was undertaken,” the strategy says.

For the past few months, the trust has been trying to decide on whether it should implement TPP’s SystmOne or Meditech in A&E, but the strategy says it is also considering developing its SEPIA ‘skin’ for that purpose. Another solution would be to upgrade Symphony to a newer Ascribe A&E system.

As EHI reported last month, SEPIA, which has been developed in-house, is being used for information and reporting functions that Meditech cannot deliver.

It is a front-end ‘skin’ that interfaces with the system and provides a ‘new look’ with better reporting design, as the trust is still struggling with usability. The informatics strategy reveals that SEPIA was created as soon as the problems began to arise.

“During the latter stages of the EPR implementation, the trust began developing a standby Meditech downtime recording and reporting system-SEPIA,” it says. “This system would be used in a disaster recovery situation and give users access to critical clinical information.”

The strategy says that SEPIA has now become a “key cornerstone” of its plans. The trust has put a bid into NHS England’s Safer Hospitals, Safer Wards: Technology Fund to develop SEPIA into a full clinical portal.

Earlier this year, it began a pilot in orthopaedics to improve clinical engagement and the strategy says it has also recruited a clinical lead for health informatics, a clinical safety officer, and a clinical IT communication and development lead.

“This strategy aims to regain clinical support by working closely with all clinicians in their day-to-day work and to derive solutions which support them, provide high quality information, and are as unobtrusive as possible,” the strategy says.