Data ‘fundamentally broken’ at St George’s

A major London NHS trust says its clinical data is “fundamentally broken”, generating ongoing concerns about patient safety.

The full extent of St George’s University Hospitals NHS Foundation Trust’s IT woes was detailed in a report to the board received at its January meeting.

“These reviews highlighted multiple operational process and technology issues that pointed to patients receiving a sub-standard level of care and potential clinical risk,” the report said.

The “poor quality” of data on referral to treatment (RTT), including cancer and diagnostic pathways “were viewed as fundamentally broken”, the report said.

The trust stopped reporting RTT figures in July last year, citing unreliable data, and has since embarked on major recovery programme.

The report said was expected to take up to two years and require engagement “from the shop floor”.

The January board papers also listed four “extreme” IT-related risks to the trust, most of which were at least “likely” and potentially “catastrophic”.

These included:

* The ongoing risk of an “unrecoverable IT system downtime”, affecting the trust’s clinical systems, web access and emails. The risk was compounded by an “outdated and unreliable” back-up system, lack of data storage and general under-investment in IT infrastructure.

* Fragmented patient records, with the trust relying on three different clinical systems, as well as paper, which could result in “inappropriate clinical decision making”.
Poor data quality, making it impossible to report RTTs and risking missed diagnoses. Concern over the data quality prompted a manual review of  1000 patients, none of whom had suffered “severe harm”.

* Ongoing ransomware attacks, some of which had already successfully encrypted trust data. The impact of these attacks had, so far, been “minimal”, the papers said.

St George’s IT problems came to light after a trust-wide network failure on 6 June, 2016.

A subsequent review revealed a range of IT problems, including “inadequately supported” software, such as XP, ageing computers, and insufficient data storage capacity.

In November, a Care Quality Commission report rated the trust as “inadequate” overall, noting its poor data quality and non-reporting of RTTs among other broader problems. The trust was subsequently placed into special measures.

The trust continues to face financial difficulties and on Tuesday announced it had appointed Marie-Noelle Orzel as its new ‘improvement director’.

St George’s uses Cerner Millennium and iSoft system in its hospitals and RiO for its mental health service. At times, the trust has been a clinical IT pioneer, becoming the first UK trust to deploy Millennium in its paediatrics intensive care unit and planning to do the same in its neo-natal unit.

However, the lack of investment in the underlying IT infrastructure has put a “freeze” on any new clinical IT deployments.

The January board papers said that the “failure to maintain and invest in the IT infrastructure for a lengthy period (7+ years) caused by a lack of funding in IT has resulted in an ‘end of life’ infrastructure that is likely to fail and result in catastrophic implication for the Trust in terms of corporate and clinical systems failures.”

In a statement provided to Digital Health News, a St George's spokesman said the trust acknowledged its IT infrastructure and data problems.

"Our data quality problems are significant, and our view is that only a complete review of our systems – and how our staff use and log patient information – will deliver the step-change and improvements required."

Since the trust stopped reporting RTTs, a dedicated team have been working on improving data quality. However, there were "no quick fixes", he said.

Efforts were already underway to stabilise the trust's IT infrastructure.

This included £1.3 million spent on replacing 750 XP computers and replacing back-up computers on wards to ensure clinical systems access during a network failure. A new IT strategy providing a "long-term solution to the challenges we currently face" would be presented to the board soon, he said.

St George’s is not the only trust to struggle with data quality. The most recent NHS England figures, from November last year, show five trusts were unable to report RTT data, the main measure for how long patients wait for treatment.

Other trusts are also struggling with ageing IT infrastructure

In December, Digital Health News reported that Leeds Teaching Hospitals NHS Trust believed 30 out of its 300 most critical IT systems and archived records “may fail without warning”. This was “caused by critical systems being held on old platforms and insufficient data storage and computers”.

Reports from Dame Fiona Caldicott and the CQC last year also sounded a more general warning about the NHS’s reliance on obsolete technology, particularly Windows XP.