Joe’s view: Lorenzo revisited

Standing on stage, microphone in one hand, bottle of lager in the other, a familiar jangling piano riff fired up on the PA system as I regarded my late night audience; which was a little the worse for wear.

For almost two years, I had worked with this extraordinary group of people. The team had decided that I would be required to give a Karaoke performance at my own leaving “do” from the Lorenzo Delivery Team.

The team had picked what I had to sing to the unsuspecting people of Solihull, who packed the bar. Backed by two female project managers who shall remain nameless (you know who you are) I duly murdered ‘Like a bat out hell I’ll be gone when the morning comes’; the Meatloaf classic.

And sure enough, the next day I was gone. Sitting in my usual seat (7A) on the 19.05 Eastern Airways flight from Birmingham to Newcastle, I wondered what the future held for Lorenzo, the electronic patient record system that the National Programme for IT was supposed to roll out across the North, Midlands and East of England.

Meanwhile, Julie, my favourite Eastern Airways flight attendant, brought me the customary gin and tonic with which I celebrated my return every Thursday from the Lorenzo Delivery Team to the relative sanity of my psychiatric clinic in Newcastle.

There was trouble, ahead

It had been emotional. Easily the most challenging job of my career. I have previously written about the challenges facing Lorenzo and described it as the problem child of NPfIT.

Back when I was recruited as medical director of the Lorenzo Delivery Team, the project was hamstrung by many factors. Not the least of them were the impenetrable national contracts born of NHS Connecting for Health (the national agency in charge of the programme).

But there was also the system of development involving innumerable hand-offs between the NHS, CSC (the ‘local service provider’ in charge of deployment) and iSoft (the company developing the software, whose development team was based in Chennai, India).

ISoft had a recent, colourful past and would eventually be taken over by CSC completely. But at that stage it was still a going concern; adding a layer of complexity, another language and culture.

When I took my leave of the project on that Thursday evening, I had little hope that it would ever deliver on those initial, hugely ambitious plans.

A beautiful sunset lit up my gin and tonic as the plane burst through the clouds above Birmingham for the last time. To capture what felt like a historic moment in my life, I photographed the scene with my iPhone (above).

Just prior to my departure, we had established the user group for Lorenzo and undertaken usability studies which we shared with the admittedly limited number of users.

Those early user group meetings weren’t easy and indicated that Lorenzo had a hard road to travel. Personally, I was out of gas and under some domestic pressure – “you’re married to that project”.  

That’s why I was out. But I tried to imagine what would become of all the amazing people that I had met in the Lorenzo Delivery Team and the good people in CSC doing their damnedest to wade through the organisational treacle and produce a decent EPR.

I feared for their livelihoods.  It was easy for me; I could just go back to being a doctor. I could still pay the mortgage. By the time I touched down in Newcastle on that last Thursday night, I was pretty sure the project would eventually fizzle out following an acrimonious wrangle over contracts and money.

Madmen (and madwomen)

I was wrong. Contracts were renegotiated, CSC bought out iSoft; presumably giving it total control with fewer handoffs. A few magnificent madmen and madwomen stayed with the project, developed the user group, and continue to develop Lorenzo.

At the CCIO Leaders Network summer school in 2013, I met Colin Brown, the chief clinical information officer from University Hospitals of Morecambe Bay NHS Trust, which was the acute ‘early adopter’ of the system.

I found a genuine bloke who genuinely believed that in Morecambe Bay they had made Lorenzo, previously the National Programme’s Aunt Sally, into a usable EPR.

Earlier in 2013, the National Mental Health Informatics network (which I chair) had run a usability survey, and some Lorenzo users had completed it.

Impressed by Colin, I took a look at the usability scores Lorenzo was achieving and saw there had been a quantum leap since I had last looked at it. Lorenzo’s usability scores now appear to be comparable with all the systems currently available.

Encouraged, I accepted Colin’s invitation to attend a meeting of the National Lorenzo user group to do a presentation on my experience with NPfIT and with the system. I was delighted and amazed to see some familiar faces at the meeting. They had stuck with Lorenzo through the very darkest days.

Butterflies. I don’t normally suffer from butterflies before a public speaking engagement but there they were. I had butterflies. Seeing Lorenzo again was like running into an old girlfriend; it didn’t work out personally – but we definitely shared something.

Getting ready to dance

The atmosphere in the room is vibrant with good clinical representation from trusts using Lorenzo. There is a series of frank presentations and a good exchange of views between CSC and users.

There is an excellent presentation about how Morecambe Bay is generating automated discharge summaries. Another trust describes the Lorenzo order comms system as the best it has ever seen. Exciting developments are in the air. Genuine clinical buzz.

I note that Philippe Houssiau gave a recent interview to EHI in which he claimed that Lorenzo was winning new business on merit.

This attracted criticism from readers along the lines of: “Well, he would say that, wouldn't he?" People also bemoaned how much money has been spent. Others appealed for full and frank assessments from users, as they did not feel that suppliers in general can be trusted.

Well, as one who has been accused of suffering from career limiting frankness I have to say that, frankly, I was impressed. For the record, Lorenzo is not vapourware; it has actually arrived. A vibrant user group is making it better. Trusts are getting ready to do some very exciting things with it.

Travelling home from the Manchester venue, sadly driving (so no gin and tonic) I felt something I wasn't sure I'd ever feel about my time with Lorenzo. I felt proud.

I felt that I hadn’t, after all, wasted two years of my life, thanks to the magnificent madmen and madwomen from Morecambe Bay to Chennai who stuck with it and who are now pushing it close to realising its huge potential.  

Finally, I’d like to nominate Colin Brown as CCIO of the year. The NHS needs all the Colin Brown’s it can get. It’s amazing what you can achieve with a good CCIO.

Joe McDonald

Joe McDonald is a practising NHS consultant psychiatrist. Over the past five years he has been an NHS trust medical director and national clinical lead for IT at NHS Connecting for Health – a stint that included 18 months as medical director of the Lorenzo delivery team!

His experiences in the National Programme for IT in the NHS have left him with a passion for usability and "end user knowledge networks.” He is the founding chairman of the National Mental Health Informatics Network. Motto: we don't get fooled again. Follow him on twitter @CompareSoftware