‘Plymouth’ offered as an interim solution

Connecting for Health has shelved plans to provide NHS acute trusts across three regions in England with an integrated, strategic next-generation clinical system for another two or three years.

E-Health Insider has learned that since late December in the North East, Eastern and North West and West Midlands regions, NHS Connecting for Health has stopped talking about LSP strategic solutions. Instead, it is begun offering some acute trusts with an urgent need for new systems an interim solution based on existing iSoft systems as currently deployed at Plymouth Hospitals NHS Trust. The new interim plan is being referred to as the ‘Plymouth’ or ‘Derriford’ option.

Sources have informed EHI that the ‘Plymouth option’ is based on versions of iSoft’s current iPM patient administration system (PAS) and iCM clinical system in use at the trust. These two stand alone systems, in conjunction with an interface, would provide a trust with a PAS together with order communications capabilities.

The need for the ‘Plymouth option’ has arisen because in the three northern clusters, where iSoft was appointed the main software provider, trusts are no longer being offered Phase One Release Two (P1R2) functionality of the Lorenzo strategic clinical software, which has been subject to repeated delays. P1R2 was meant to include clinical tools such as order communications and provide a key step towards detailed local integrated electronic care records.

CfH, the agency responsible for the National Programme for IT (NPfIT), awarded contracts to LSPs and their sub-contractors, based on the phased delivery of a next generation clinical solution provided through five progressively more sophisticated software releases up to 2010 – each one adding new clinical capabilities.

In the North West and West Midlands, North east and Eastern regions – where iSoft was sub-contracted to deliver a next generation clinical system – this incremental release strategy now appears to have been put on hold.

Under the ‘Plymouth option’ versions of iCM and iPM would be provided as an interim solution to trusts with an urgent need for new systems that are unable to wait until 2008 – the earliest date now being talked about for delivery of the strategic LSP Lorenzo clinical solution, being developed by iSoft.

A hospital IT director in one of the regions affected said of P1R2. “It’s a dead topic. We went through all that and its just history now.” He said that after repeated delays and revised implementation schedules talk of P1R2 “just petered out” ahead of Christmas.

He added: “The schedule got moved around to the point that you realise nobody’s talking about it [P1R2] any more and all the dates have passed. The communication is now all ‘do you want to take the Plymouth interim option’.”

Explaining his trust’s local situation, he said: “The LSP are saying that a basic PAS is available now – but for an organisation like us it’s just not fit for purpose. Facing the unstable environment of life as a foundation trust, we will need far more sophisticated tools such as tracking of patients, order communication, care pathways, intelligent rules-based ordering and reporting of pathology and radiology.”

In December 2005, Norfolk and Norwich NHS Trust cited similar concerns as the reason for its decision to shelve the local LSP, Accenture’s, implementation of an iPM PAS system.

The anonymous trust IT director stressed, however, that he remained fully committed to the broad objectives of the NHS IT Programme “it’s got to be the right way to go”, and said his trust would take the LSP strategic solution “when it’s fit for purpose”.

“We want to be pragmatic. If the Plymouth option is up to scratch we will take it. If not we’ll have to look for alternatives,” he added.

“One of the key questions yet to be answered is what interim would actually mean, and whether there was a coherent migration path from the Plymouth product to the LSP’s strategic solution when finally available,” he told EHI. “As I understand it, the architecture for the Plymouth products is substantially different to Accenture Lorenzo.”

Another trust IT director told EHI that details of the ‘Plymouth option’ were still unclear, and that the latest information he had was that Accenture were evaluating the system.

As an interim solution he said that he’d be willing for his trust to examine the ‘Plymouth option’. However, he added that he had almost no information on the proposed solution and trusts were currently being told not to contact Plymouth directly.

iSoft chief executive Tim Whiston told EHI that the approach taken by CfH has pragmatically developed since contracts were awarded: "There has clearly been evolution in what the programme has been seeking to achieve and how best to achieve it." He said there was now an opportunity to "look at what is the best way to deliver the greatest value in the shortest possible period".

Whiston added: "I’m encouraged by the discussion and dialogue that now takes place, pragmatism will prevail, and we’ll deliver something of real value on a large scale and still provide something that enables us to then go on and deliver some of the more strategic ambition that still sits within the programme."

EHI understands, though, that some trusts are proving reluctant to take the Plymouth option. Some trusts in NWWM, are believed to have already passed on the option because it doesn’t take them much further than they are already. Based on Plymouth’s own experience it is also questionable whether the approach offers a quick fix interim solution.

Plymouth first signed with iSoft for iPM in 1999 which is now used trust-wide. It then contracted for the iCM order communications system in 2003, with a pilot going live on the haematology ward in June 2005. At Plymouth iPM and iCM are separate systems that share a common interface. Nick Thomas, IT director at the trust recently told EHI a business case was now pending to roll the iCM system out trust-wide.

He said that the trust was pleased with the progress it had made working with iSoft, but stressed that a 12-month lead time had been required before going starting to go live with order communications. Thomas said that order communications had recently gone live on a second ward and estimated it would be trust wide “within about 18 months”.

A spokesperson for Accenture told EHI: "Our approach has always been that, over the course of the National Programme, we will incrementally enhance the breadth and depth of IT service provision to the trusts in our two clusters. In the acute sector, for example, our initial deployments have focused on patient administration. During 2006 we will be adding to this and providing clinical support in areas such as order communications and results reporting. We will then be adding further clinical functionality and integration across care settings in due course."

The spokesperson added: "Our approach to each phase of deployment will be to use available software wherever possible and to bring new services to our trusts with minimal disruption and when they are proven to be clinically reliable and robust. In developing our detailed deployment plans we work closely with all our software vendors to understand and align with their roadmaps for the introduction of new technology."