System Reliability and Performance

From Nhs It Info

Contents

NHS User Survey: Appendices 1-6 (17 Jun 2005)

TFPL Ltd. for NHS NHS Connecting for Health

http://www.library.nhs.uk/nlhdocs/Appendices_1-6.pdf

"Not surprisingly the professional population canvassed are comfortable using e-resources though not everyone was confident that they used them well. House officers experience frustration with changing Athens passwords as they moved locations. Manager's views of Athens were mixed – some had no issues, others experienced technical unreliability. Firewalls present another issue – managers get over this by using some resources from home. . . Access to Athens needs to be more reliable and easier to use. Athens takes too long to use and access is not technically reliable enough."

Patient data errors created by iSoft's iPM system (9 Jan 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=1632

"A flaw has been identified in the iSoft iPM patient administration system being provided as the standard solution to NHS trusts in the North West and West Midlands that can corrupt patient data creating suspected clinical risks to patients"

A spineless performance (12 Jan 2006)

The Guardian

http://society.guardian.co.uk/e-public/story/0,,1684068,00.html

"The system at fault was not the booking software as such, but in the underlying digital "spine" supposed to connect all parts of the NHS in England. Officials had previously boasted that the spine would be available 99.8% of the time, with recovery within 30 minutes of any crash. . . The trouble began on December 18 with the installation of a major upgrade of the spine software. . . The new software reacted badly with one of the many different systems used by GPs to manage their practices, and generated spurious messages that overwhelmed networks and servers. This rogue behaviour masked other incompatibilities between the new demographics service and the "choose and book" software. "We were into Christmas before we were able to start diagnosing," said one of the team who worked over the holiday to resolve it."

Paper working after disaster 'not acceptable' (1 Feb 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=1678

". . . some acute trusts in Accenture's regions found their patient administration systems (PAS) were not working for a week and had to go back to working on paper."

COVER (Cover of Vaccination Evaluated Rapidly) Programme: January to March 2006 (22 Jun 2006)

Communicable Diseases Report Weekly

http://www.hpa.org.uk/cdr/archives/2006/cdr2506.pdf

". . . This is the third quarterly report in which national trends could not be reported due to problems with new child health systems being implemented in London. Comparing the year 2005/6 to 2004/5, the number of children in London who are missing from the COVER programme is nearly 18,000 for children turning 12 months, over 14,500 for children turning 24 months and nearly 19,000 for children turning 5 years of age. These children are not necessarily unvaccinated, but the fact that no information has been collected on their vaccination status means that those who have missed out vaccines for whatever reason are unlikely to have been identified and followed-up. Child Health Systems were created to help manage the national vaccination programme at the local level in the 1980s. The systems were very successful in achieving greatly improved vaccination coverage in the UK through sending invitations for vaccination, identifying unvaccinated children, sending reminders and tracking their status for catch-up campaigns. If new child systems fail to deliver these functionalities then children risk missing out on vaccination. Thus, they remain unprotected and eventually will catch measles, mumps, and rubella infections. Ten of the 31 London PCTs are using CHIA, a system provided by BT which is the London provider for Connecting for Health, the agency delivering the NHS National Programme for IT. . ."

Fears over faults in NHS patient records system (25 Jun 2006)

The Observer

http://observer.guardian.co.uk/uk_news/story/0,,1805437,00.html

"The multi-billion pound computer system built to run NHS patient records is experiencing so many problems that there are concerns people could be put at 'clinical risk', with missed appointments and lost records meaning that some hospitals have pulled out of the scheme in despair. Confidential documents and emails obtained by The Observer reveal the scheme's progress is plagued by technical problems that threaten lengthy delays for patients needing to see specialists. . . Industry sources familiar with the project told The Observer that the problems have seen many hospitals or trusts postpone the system's implementation. Just 12 of England's 176 major hospitals have implemented even the most basic part of the new system which electronically books patient appointments with specialist consultants - despite the fact 104 had agreed to have it operating by April. Furthermore, not one NHS trust or hospital in England has implemented the second phase of the system, which will allow doctors to order clinical services such as blood tests or X-rays electronically - contrary to the Department of Health's planned timetable.

Experts try to fix NHS IT failure (1 Aug 2006)

BBC News

http://news.bbc.co.uk/1/hi/health/5233604.stm

“Technicians are trying to solve a computer failure that has prevented 80 NHS trusts gaining access to patients' records and admissions since Sunday. Eight major hospitals and more than 70 primary care trusts in north-west England and the West Midlands were hit. . . The problem affects trusts in Birmingham and the Black Country, Cheshire and Merseyside, Cumbria and Lancashire, Greater Manchester, Shropshire and Staffordshire and the southern part of the West Midlands. Computer company CSC, which runs the system, said experts were working around the clock to resolve the situation. A spokesman for NHS Connecting for Health, which oversees the multi-billion pound NHS IT service, said that no data had been lost, and that the incident was caused by "storage area network equipment failure".”

NHS computer system 'won't work' (6 Aug, 2006)

The Observer

http://observer.guardian.co.uk/politics/story/0,,1838470,00.html

Leaked analysis says hospitals would be better off without national upgrade. The project to overhaul the NHS's computer systems, costing millions, is so beset by problems that hospitals would be better off if they had never tried to implement it, according to a confidential document apparently sent by one of the scheme's most senior executives. A 12-page analysis detailing why the project will never work was sent anonymously to an MP on the Public Accounts Committee from the computer of David Kwo who, until last year, was in charge of implementing the Connecting for Health system across London. . . Kwo did not return emails or telephone calls from The Observer, but the Microsoft Word document reveals that it was written on his computer. What is irrefutable is that the devastating analysis of the flawed computer system - which is two years behind schedule - could have been written by only a handful of senior NHS IT experts who have worked on the project. 'The conclusion here is that the NHS would most likely have been better off without the national programme, in terms of what is likely to be delivered and when,' states the document, sent to Conservative MP Richard Bacon and obtained by The Observer. 'The national programme has not advanced the NHS IT implementation trajectory at all; in fact, it has put it back from where it was going.' As the problems have increased, GPs' surgeries have opted to implement their own systems, something which the document observes is 'fragmenting the national programme further'. Many hospitals are 'being forced to deliver outdated legacy systems, which the programme was established to replace.

E-mail reveals outage disrupted patient care (7 Aug 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2054

“One week on from the computer failure that left 80 trusts in the North-west and West Midlands without access to their IT systems the extent of the disruption to patient care of the biggest ever NHS IT failure is coming to light. Despite claims to the contrary by NHS Connecting for Health, E-Health Insider has received documentation showing the failure disrupted patient care at Birmingham Children’s Hospital (BCH) NHS Trust - one of eight acute trusts that lost access to patient data last week. As a result BCH has begun a review of its contingency arrangements. . . An internal e-mail from Richard Beekan, the trust’s director of operations, is explicit about the impact the loss of the Lorenzo patient administration system had. Once the trust lost access to the patient administration system (PAS) it had to revert to paper based “business continuity systems. This system was introduced expecting the system only ever to be unavailable for a maximum of 12 hours and therefore during the last three days we have experienced issues we had not planned for. In particular the absence of our case note tracking system and an ability to know where notes were had an impact in both out patients and inpatient areas.” Last week NHS Connecting for Health (CfH), the agency responsible for the NHS IT modernisation project, publicly stated in bulletins that the failure at the CSC data centres had no impact on patient care. On 2 August, CfH said: “To date no impact on the delivery of patient care has been reported.”

NHS suppliers face review of disaster plans (15 Aug 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/08/15/217689/NHS+suppliers+face+review+of+disaster+plans.htm

“Connecting for Health (CfH), which runs the National Programme for IT in the NHS, has ordered a review of disaster recovery arrangements for all five of its local service providers following failures at a datacentre run by CSC earlier this month. The outages left hospital trusts in the North West and West Midlands without access to patient administration systems for up to five days. CfH contracts with local service providers specify that storage area networks at the heart of disaster recovery provisions must have no single point of failure, 99.9% availability and zero data loss. “The disaster recovery restored time within contracts depends upon the services affected. This is currently between two and 72 hours. However, by January 2007, all services must be restored within two to 12 hours,” said a CfH spokesman.”

Choose & Book - A Report from the Streets (Summer 2006)

UK Health Informatics Today

http://www.bmis.org/ebmit/2006_50_summer.pdf

". . . At the time of writing my PCT has 30% of practices who have absorbed CAB usage into most of their daily activities – but of course that means 70% have not. Even to have got this far was largely due to the incentive payments put in by the government. There is no proper documentation of the system and little information on exactly when users should go to their local help desk or when to escalate problems to the national team. System reliability has been patchy. This doesn’t sound that bad but what does it foretell about the launch of the other parts of the programme? There is no way to let users know when the system goes off line - not even a simple information cascade. This is a system that should be resilient, fault tolerant, and hot swappable with real 24x7x365 availability. Well it doesn't provide anything like this level of reliability. . ."

Major incidents hit NHS national systems (19 Sep 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/09/19/218552/Major+incidents+hit+NHS+national+systems.htm

"More than 110 "major incidents" have hit hospitals across England in the past four months, after parts of the health service went live with systems supplied under the £12.4bn National Programme for IT (NPfIT) in the NHS. Many of the incidents, which have been reported by Connecting for Health, the body that oversees the NPfIT, involve the failure of x-ray retrieval hardware and software, known as Pacs (picture archiving and communications systems) which allow clinicians to view digitised x-rays on screen. . . The major incidents also involve hospital patient administration systems, which hold patient details such as appointments and planned treatments. The specifications for services to be supplied under the NPfIT built up an expectation among NHS staff and clinicians that they would receive sub-second response times, and that equipment would be available to them 99.99% of the time. But the list of major incidents seen by Computer Weekly shows that in some cases NHS staff and clinicians have lost access to their main hospital systems. More than 20 major incidents have affected multiple NHS sites. This raises questions about whether the risks of failure after go-live have been adequately assessed, and whether any independent regulator has an overview of the riskiest implementations across England. . . Some of the listed incidents were fixed quickly, though others lasted much longer. . ."

NPfIT systems failing repeatedly (20 Sep 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2144

“More than 110 major incident failures have been reported by hospitals and GPs over the past four months relating to systems provided by the NHS National Programme for IT. The problems, which have affected dozens of hospitals across England, were serious enough to be logged by NHS managers as ‘major incidents’. The issues were revealed by an anonymous NHS IT director speaking to Computer Weekly. The IT director told the magazine: "Some NHS trusts that have implemented Connecting for Health [centrally-bought] solutions are struggling to cope with poor system performance and service availability issues. "The local service provider is working flat out to resolve the issues. However, a great deal of damage has been done in terms of deteriorating end-user confidence and satisfaction with respect to the systems." E-Health Insider understands that the 110 serious incidents reported by Computer Weekly may actually understate the true number of problems. Industry sources say that some problems are routinely not reported or recorded or classified as less serious. For instance, the July data centre failure that affected 80 trusts is understood to have been counted as a single major incident. EHI has also learned that a 9 September failure that resulted in the iSoft system delivered by Computer Sciences Corporation to Morecambe Bay Hospital NHS Trust becoming unavailable to all staff was only treated as an 'amber' incident, rather than a 'red' major incident. The contractual specifications for services to be supplied under the NPfIT say that staff and clinicians will receive sub-second response times, with 99.99% availability. But in many cases staff have found systems can either be extremely slow, impossible to access or unavailable to them for hours or even days. . . While the early problems will hopefully just prove teething problems, they raise the spectre that staff will not be able to fully rely on CfH systems and will still need to maintain old systems and paper records. The programme has yet to begin widespread delivery of clinical rather than administrative systems. . .”

Some N3 links 'too slow for Choose and Book' (25 Sep 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2151

"A fanfare for the near completion of the new NHS network, N3, has been met with complaints that some GP practices with new broadband connections are not receiving enough bandwidth even to use the e-referral system, Choose and Book, effectively. Announcements last week from the network’s purchaser, Connecting for Health, and supplier, BT, brought numerous comments from E-Health Insider readers who were critical of the performance experienced by some users. Clinicians in affected areas who attempt to use Choose and Book through their clinical applications are experiencing login times of up to four minutes and finding their keyboards unresponsive. Meanwhile, users are unable to distribute critical application patches and updates over their connections and GPs are reportedly "tearing their hair out". . . The difficulties are causing problems on a regional as well as a local level. Last month, EHI understands, a primary care trust in Leeds was unable to agree a go-live date due to the poor performance speeds of N3 over their intra-practice virtual private network. . ."

Hospital blames IT for fall in status (17 Oct 2006)

Computer Weekly

"Executives at a hospital that pioneered systems under the £12.4bn National Programme for IT in the NHS have blamed their new technology for contributing to the trust's loss of status as top performing health service site. The Nuffield Orthopaedic Centre in Oxford was last year awarded the maximum three-star rating for its performance. Under a new method of rating hospitals, Nuffield was categorised by the Healthcare Commission as "weak" for quality of service. This is the bottom category of performance. The ratings matter because hospitals can lose business - and income - if their ratings remain poor and patients are referred elsewhere. On a target for seeing patients with suspected cancer, Nuffield incurred a "fail" because it was unable to submit the necessary data during the implementation of its new systems. It also failed to meet national targets on the number of patients waiting more than six months and on the number of cancelled operations. Jan Fowler, acting chief executive at Nuffield, said she was disappointed at the "weak" rating. "We believe we are providing a good quality service to our patients at this hospital but the results have been distorted by the computer problems we had earlier this year following the installation of our new patient administration computer system, which unfortunately caused some patients to experience delays to their treatment," she said. . ."


Trust feels pain of NHS IT roll-out (7 Nov 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/11/07/219625/trust-feels-pain-of-nhs-it-roll-out.htm

"Queen Mary's Sidcup NHS Trust was an NHS IT trailblazer late last year when it became the first trust in London to use the new patient administration system from the £12.4bn National Programme for IT (NPfIT). But alongside the technical challenge posed, trust chief executive Kate Grimes said last month that its commitment to tapping the NPfIT had also left it under financial pressure and facing an income loss of about £3m. This was due to problems encountered when rolling out the new systems from BT, which is the local service provider for national programmes in London. . . Problems with the new system began as soon as it went live in November last year. Grimes said the system was sometimes unavailable and problems with logging in were adding 36 minutes to the time patients spent in the hospital, simply because of the time wasted gaining access. This contributed to the trust just missing its accident and emergency targets for the year. The main threat to the trust's finances came from the drop in referrals because other hospitals in the area had started using the NPfIT's Choose and Book system to allow GPs to book appointments online. However, the Sidcup trust found out just before it was due to go live with the Carecast patient administration system from IDX that the system was incompatible with Choose and Book. Although the problem is now fixed, there has been a significant drop in referrals in the meantime, Grimes said. "If it had gone on for many more weeks the survival of the organisation would have been threatened by that." Another fall in revenue came from the clinical coding systems introduced as part of the new software. Hospitals need to code their procedures so that they can be paid by the government. "The new coding took a lot longer to do and a number of patients were not on the system - so you do not get paid for them," Grimes said. This was due to system downtime, lack of training and a struggle with the new role-based access approach to the application, she said. . . As Computer Weekly revealed last week, trusts are having to live with the consequence of decisions made by NPfIT contractors, which they have no part in making, with limited means to seek recompense. A lack of contractual control was a drawback to the design of the programme, Grimes said. "There is a lack of visibility of the contract or any power or control over it. If a delay increases my costs, I do not have any power to recover those costs." She said that BT had "helped out", but it was not something that was automatic in the contract. Another drawback to the structure of the programme, which is managed by Connecting for Health, is that problems take a long time to resolve because of the lengthy chain of command. . ."

NHS broadband leaves GPs in slow lane (21 Nov 2006)

e-Health Insider

http://www.ehiprimarycare.com/news/item.cfm?ID=2282

"Many GP practices are struggling with inadequate broadband speeds over N3 (the new NHS National Network) which are slowing down their day-to-day work and limiting their ability to use key national computer systems from the £12.4bn Connecting for Health programme. Fair Deal on NHS BroadbandChoose and Book has been particularly affected and GPs have told EHI Primary Care about the frustrations of trying to deliver the e-booking system with the connection speeds available to them. The problem particularly affects branch surgeries, linked to main practices. The problems are being exacerbated because primary care trusts say they cannot afford to buy additional bandwidth for practices from N3 service provider (N3SP) BT with quotes of up to £30,000 to upgrade a practice from a 1MB to 2MB line. The costs are partly thought to be so high because the price list is based on a seven year contract NHS Connecting for Health (CfH) signed with N3 provider BT at the beginning of 2004 when bandwidth was more expensive. BT and CfH are coming under pressure to review the contract so that it better reflects market conditions and delivers adequate broadband speeds for practices at an affordable price. . ."

CfH GP group to discuss N3 speed problems (28 Nov 2006)

e-Health Insider

http://www.ehiprimarycare.com/news/item.cfm?ID=2301

"GP practices’ concerns about N3 are to be discussed at the next meeting of NHS Connecting for Health’s GP Pan User Group (GP PUG). Dr Gillian Braunold, joint GP national clinical lead for CfH, told EHI Primary Care that N3 will be on the agenda at the pan user group’s January meeting. Last week EHI Primary Care launched its Fair Deal for NHS Broadband campaign to highlight the problems facing primary care and secure a fair deal for GP practices on NHS broadband. Dr Braunold said she and Professor Mike Pringle, her co-GP clinical lead, had already passed on to the N3 team concerns about the BT-run NHS network raised during CfH’s current series of GP engagement events around the country. Issues practices have highlighted to EHI Primary Care include concerns that practices do not have adequate broadband speeds to use systems such as Choose and Book, that the cost of upgrading must be met locally and can be as high as £30,000 for a three year contract, and that inadequate broadband speeds are particularly affecting branch surgeries where the impact is felt not only on national applications but also on GPs’ clinical systems. . ."

N3 Internet gateway fails across NHS (7 Dec 2006)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2326

"Users of the NHS broadband network across England were left unable to access the internet for about two hours on Tuesday due to a problem with the internet gateway. The failure left NHS users unable to access the web-based version of Choose and Book or web-based clinical knowledge sources. The fault is believed to have affected N3 and N2 – the predecessor to the N3 network - users across England although service provider BT told EHI Primary Care that it was not possible to accurately identify how many people were affected as the problem was intermittent. A spokesperson added: “It was down for about two hours.” GP practices and hospitals across the country reported lack of access to the internet and those using web-based Choose and Book were also unable to access the e-booking application. . . The embarrassing failure came in the same week that BT announced its N3 national service team had achieved the international ISO 20000 standard for effective IT service management."

GPSoC delivery goes local in IT devolution (11 Dec 2006)

e-Health insider Primary care

http://www.ehiprimarycare.com/news/item.cfm?ID=2333

"Local NHS organisations will be required to draw up plans showing how they will deliver GP Systems of Choice implementation under new arrangements announced today. Primary care trusts, as commissioners, will be required to have their own comprehensive IM&T plan and work with all providers in their local health communities to align IM&T plans to enable patient-centred service transformation. The new requirements are part of a broad strategy of devolving responsibility for IM&T to local level announced in ‘The NHS in England: the operating framework for 2007-8’. The framework was launched by NHS chief executive, David Nicholson, who says in his foreword: “We are devolving power from the centre to the service in many ways, not least in how we allocate money, such as the unbundling of central budgets. “Some of the key enablers of service transformation, such as the delivery of information technology, will also increasingly need to be driven and owned by the service rather than from the centre so that patients can get the full benefits as quickly as possible.” Nicholson is currently reviewing the National Programme for IT (NPfIT) and reports suggested he was keen to improve local ownership of the programme. . . Plans will be required from NHS organisations showing not only how local but national priorities will be achieved. These include: the completion of picture archiving and communications rollout; implementation and benefits realisation for the Electronic Prescriptions Service and further exploitation of e-booking. . . In addition to the responsibilities set out for PCTs, as commissioners, all NHS providers will have to have a forward looking IM&T plan which is “core to their business, exploits fully the NPfIT opportunity and thereby demonstrates migration to the NHS Care Record Service.”

No warning for hospital on patient system problems (12 Dec 2006)

Computer Weekly

http://www.computerweekly.com/Articles/2006/12/12/220509/no-warning-for-hospital-on-patient-system-problems.htm

"A hospital trust in Oxford which lost track of crucial data on some patients after going live with a pioneering project under the £12.4bn NHS IT programme was unaware that a similar go-live at another hospital had led to a "serious untoward incident". This is one of the findings of a joint investigation by Computer Weekly and Channel 4 News. The results of the investigation were broadcast on Channel 4 yesterday evening (11 December). In December 2005, the Oxford-based Nuffield Orthopaedic Centre installed a Cerner patient administration system as part of the National Programme for IT in the NHS. The go-live led to the trust reporting a serious untoward incident to the National Patient Safety Agency because of what the trust's executives called "potential patient risks". Martyn Thomas, a visiting professor of software engineering at Oxford University, told Channel 4 News, "It is alarming. If there are known problems then they really ought to be communicated very rapidly to other users of the system." The Computer Weekly and Channel 4 News investigation also raises questions about the National Programme in general. A hospital consultant, Gordon Caldwell, said that if systems were too slow and badly designed, they could be a major threat to the way hospitals in England work. . ."

BT investigates slow connections for GPs (19 Dec 2006)

e-Health Insider Primary Care

http://www.ehiprimarycare.com/news/item.cfm?ID=2362

"N3 provider BT has been investigating ways in which it might improve its service for GP practices using the EMIS computer system which have been struggling with slow connection speeds to their branch surgeries. EHI Primary Care understands that BT has been running experiments on alternative configurations and that solutions identified by that work will be rolled out early in the new year. EHI Primary Care’s Fair Deal on NHS Broadband campaign, launched in November, has been highlighting problems faced by GP practices with N3 connections with the aim of securing a better service for primary care. Staff working in branch surgeries have faced particular difficulties where the N3 connection via a virtual private network (VPN) connection to the main surgery means even opening attachments such as consultants’ letters or clinical photographs can be painfully slow. In some cases GPs have reported occasions where there has been a delay of several seconds between making a keystroke and the character appearing on the screen. . ."

£600,000 payout over NHS 'crash' (10 Jan 2007)

Manchester Evening News

http://www.manchestereveningnews.co.uk/news/health/s/232/232837_600000_payout_over_nhs_crash.html

"THE North West NHS is to get £600,000 compensation after their new hi-tech computer system crashed for two days. Health staff were forced to revert to pen and paper after Connecting for Health - and its back-up - went down last July, affecting about 2,000 patients in Greater Manchester because of theatre management and appointment-booking systems. IT firm Computer Science Corporation Alliance has now agreed to pay £600,000 towards extra administration costs after staff had to make provisional appointments using paper lists, then confirm them by computer once the problem was solved. The programme to centralise and computerise all NHS systems and records has been dogged by delays. Some Greater Manchester hospital bosses are still refusing to switch to the new software because they say it is not up to the standard of their current systems. . . Pennine Care Mental Health Trust, North Cheshire Hospitals and South Manchester Primary Care Trust, which runs clinics at Withington Community Hospital, were said to be the worst affected trusts in this region. At Bolton, computerised theatre management systems were hit. The software tracks details of all surgical procedures - even down to which scalpels are used for each operation and where and when they are cleaned. . ."

GP Systems of Choice procurement on track but late (23 Jan 2007)

e-Health Insider Primary Care

http://www.ehiprimarycare.com/news/item.cfm?ID=2435

"The GP Systems of Choice (GPSoC) scheme looks likely to go ahead - although procurement will not be complete by 1 April as originally planned. A spokesperson for CfH told EHI Primary Care that the GPSoC business case was approved by the Department of Health in December 2006. Approval from the Treasury is still outstanding but EHI Primary Care understands the scheme is likely to be given the go-ahead in the next few weeks. Once Treasury approval is received CfH will go out to tender for suppliers to take part in GPSoC through an advertisement placed in the Official Journal of the European Union (OJEU). This process is likely to take a minimum of 90 days so procurement will not be complete by 1 April as CfH had planned. . . Work on providing a scheme to provide GP practices with the IT choice outlined in the GP contract in 2003 has been dogged with delays and difficulties. A previous scheme first mooted in 2005 which would allow GPs access to any system so long as it had a contract with a local service provider was scrapped because it could not be made to work and it was decided it would not offer the NHS value for money."

South Warwickshire authorises shared smartcard use (30 Jan 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2449

"South Warwickshire General Hospitals NHS Trust has confirmed that its board has agreed that clinicians working in part of its A&E Department can share smartcards to access patient records. The trust passed the policy after deciding that the lengthy log-in times, averaging 60-90 seconds, it takes staff to log-on to the hospital's new patient administration system (PAS) every time they use it was not acceptable in a busy A&E environment. South Warwickshire's new iSoft iPM PAS, which is connected to a national data spine, has been supplied by Computer Sciences Corporation as part of the NHS National Programme for IT (NPFIT) modernisation programme. Reports of lengthy log-ins have also reported from other trusts that have received NPfIT systems connected to the spine. Following implementation of their new iPM Patient Administration System by CSC in December, the trust’s board allowed clinicians in A&E to share smartcards due to the lengthy login times for the new PAS. A spokesperson for the trust told EHI: “Count the time in your head and think of all the patients in A&E, 60 – 90 seconds is a long time.” . . . A spokesperson for the British Medical Association commented: “We would not support the sharing of smartcards by NHS staff accessing computerised patient records. Sharing access not only puts at risk the security of the system but also disrupts the audit trail which tracks who has accessed parts of the record.” . . . Connecting for Health says that it has commissioned software upgrades that will eventually significantly reduce log-in times."

Paul Charlson: We need a new start for NHS on the critical list (6 Mar 2007)

Yorkshire Post

". . . Apart from failing to control costs, the Government has made some new very expensive commitments. One of these is Connecting for Health. This is the central computer system encompassing, among other things, a central medical record and the ability to book outpatient appointments from the doctors' surgery. We started to use Choose and Book nine months ago. The system is supposed to come up with appointments virtually instantaneously. The first time I used it, I looked like a real lemon, staring at a blank screen for five minutes. The patient went away without an appointment and my secretary spent ages creating an appointment for her. This was repeated many times by our practice before we gave up. Even the National "hit squad" is struggling to sort out our problem. We are not an isolated case. Three things seem to have gone wrong with Connecting for Health. First, the time scale for its introduction was hopelessly short. Second, many good systems that were already operating around the UK have been dumped. Third, an IT system must assist its users to do their job better. This is not happening. Choose and Book should be suspended until it can made to work properly. Current systems should be supported until they can be integrated and there should be more consultation with clinicians in future developments. . ." [Dr Paul Charlson is a GP in East Yorkshire and member of Doctors for Reform. He was previously a member of East Yorkshire PCT executive committee.]

Hospital patient records system is a 'nightmare' (30 Mar 2007)

Milton Keynes News

http://www.mk-news.co.uk/mknews/DisplayArticle.asp?ID=77775

"A doctor has slammed the Government's new multi-billion pound patient records system after service levels at Milton Keynes Hospital plummeted due to a series of early problems. CRS, supplied by Fujitsu as part of the £12.4bn NHS National Programme for IT, replaced a 20- year-old system which was viewed as slow and out-of-date. The new service has been promoted as a faster, modernised way of storing patient records on computers rather than using handwritten notes. But consultants and front line staff are already cursing the system as records became lost in the changeover. Speaking at a recent trust board meeting, Dr Richard Butterworth said: "Outpatients is currently a nightmare with no notes. "The new system meant that 40 patients had no sets of case notes. If these problems are insurmountable this is not good news. We spent months setting up new clinics but they are no longer visible on CRS. If these are teething problems that's great but otherwise I have concerns. It's much harder to see followup patients if you haven't got the old notes." The go live date was originally scheduled for August 14 2006 but was put back so that glitches in the system could be fixed. Staff have been forced to work extra hours on their shifts to help deal with the problems. The trust has argued that the system is still developing and that problems have to be expected but the long term benefits are significant. But board members said there are still glitches and called for more staff to be brought in to help ease the crisis. Finance director Rob Baird said: "CRS is one of the biggest things that has happened in the organisation. "It's been an exhausting process for many of our staff and people have worked way beyond the expectations we could have of them. The service to our patients in some areas has diminished in this period. At the moment we have quite a confused situation and it's like everyone had started a new job. We are doing everything we can and I understand there's huge frustration. It's not possible to go back to the old system so we have to be positive. One of the problems was the system that we trained on was not the system that we went active with, it was a training version that was different. We have found that in some areas it's not been as good as we would like it to be." CRS has also gone live across the community hospitals of Milton Keynes Primary Care Trust, the first step to making a shared care records system available across the local health community, which serves a population of 230,000."

Hospital’s computers ‘a failure’ (3 Apr 2007)

The Times

http://www.timesonline.co.uk/tol/news/uk/health/article1605125.ece

"Medical and secretarial staff at a hospital have declared a new computer system as “not fit for purpose”. The Patient Administration System introduced to Milton Keynes General Hospital five weeks ago as part of the Government’s £12.4 billion IT scheme for the NHS, is not working, say 79 members of staff in a letter to the hospital’s management. The setback is the latest to hit the National Programme for IT, run by Connecting for Health, a government agency. The rebellion at Milton Keynes emerged as Computer Weekly reported that Connecting for Health had sought to suppress a critical report into the system by the British Computer Society. In their letter, the staff at Milton Keynes say the software is “awkward and clunky”. “In our opinion, the system should not be installed in any further hospitals.”"

Stop roll-out of this records system, urge NHS doctors (10 Apr 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/04/10/222939/stop-roll-out-of-this-records-system-urge-nhs-doctors.htm

"Dozens of users of a system delivered under the NHS's £12.4bn National Programme for IT (NPfIT) want the technology withdrawn - though they have praised IT staff and the supplier for the "heroic" work involved in the go-live. Seventy-nine doctors, nurses and other end-users at Milton Keynes General Hospital have written a letter saying a new Care Records Service system is "not fit for purpose". The Care Records Service is the pivotal part of the NPfIT, the aim being to provide an electronic health record for 50 million people in England, accessible by any authorised clinician. Major NHS organisations across England are contractually bound to take the Cerner Millennium-based Care Records Service. Milton Keynes General Hospital was one of the first five to go live with the service in Southern England. Several other early adopters have also had difficulties keeping hospitals running smoothly after going live with the system. The Milton Keynes letter said the technology was so awkward and unaccommodating that, "We cannot foresee the system working adequately in a clinical context." It added, "It should not be installed in any further hospitals. If it is not already too late, there is a strong argument for withdrawing the Care Records Service system from this hospital." The Milton Keynes News reported that Richard Butterworth, a doctor at the hospital, told a trust board meeting last month, "Out-patients is a nightmare, with no notes. The new system meant that 40 patients had no sets of case notes." Hospital finance director Rob Baird told the board, "At the moment, we have quite a confused situation." Fujitsu said in a statement that there had been some "high-impact problems" and it regretted any inconvenience caused to patients and clinicians. Of the 16 issues outstanding at go-live, six were of greater priority and five of these had been resolved, said Fujitsu. The others were being investigated. A spokesman for NHS Connecting for Health, the agency running the NPfIT, said the Milton Keynes trust identified some "unacceptable problems" and no payments would be made to Fujitsu until the system was working satisfactorily. . ."

'Heroic' staff can't hide flaws (10 Apr 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/04/10/222891/heroic-staff-cant-hide-flaws.htm

"The sad thing about the IT-related crises at Milton Keynes General Hospital is that everyone involved wanted its "early adopter" systems installed under the NHS National Programme for IT (NPfIT) to succeed. . . Staff at Connecting for Health, which runs the NPfIT, worked hard to ensure success. But the problems seem to be getting more serious. We do not blame software supplier Cerner. It has a good US-based product that is proving a challenge to anglicise. Yet NHS trusts across Southern England are contractually obliged to install it. There comes a time when a minister has to say, 'Do we really want to continue with this sort of disruption? Or is there a better way, even if we have to admit we got some important things wrong when we first announced the programme?'"

Milton Keynes MP asks when Millennium will be fixed (20 Apr 2007)

e-Health Insider

http://www.e-health-insider.com/news/item.cfm?ID=2628

"Reports of missing patient records resulting from the new Cerner Millennium system at Milton Keynes NHS Trust have led local Member of Parliament, Mark Lancaster, to write to the Health Secretary to ask when the Care Records System at the trust will be "fit for purpose". The system has been provided by local service provider Fujitsu as part of the £12.4bn NHS National Programme for IT but has been dogged by problems including clinic lists not being available, patient notes being lost or unavailable and problems with reporting around key areas such as 18-week waits. One senior clinician from the trust described the situation in outpatients as "a nightmare". . . The MP's letter to Health Secretary Patricia Hewitt came in the same week that local paper, Milton Keynes News, reported on the experiences of patients who had suffered the consequences of lost records. One patient, Michael Rooney, who suffers from glaucoma and relies on regular treatment at the hospital, told the paper: "For about five weeks now they've been unable to find my notes. The first time, they said you must come back in five weeks but when I did they said they hadn't found my notes. I'll be blind by the time they find them." He added: "My wife was in intensive care and the doctor said he was glad he knew her because he couldn't find her notes either." Lancaster said of the ongoing problems at the trust: "Despite patient service suffering it appears that no substantive action has yet taken place, this is absolutely unacceptable and why I have to resort to raising the issue in parliament today." In a written parliamentary question the MP asks the Health Secretary to detail "what steps are being taken to ensure that the Care Records Service computer system at Milton Keynes hospital is fit for purpose; and when this work will be complete". Responding on behalf of Hewitt, health minister Caroline Flint replied in a Parliamentary answer: "Urgent and priority action is being taken to manage resolution of the operational difficulties which have been experienced with the new acute patient administration system (PAS) at Milton Keynes general hospital national health service trust since it went live on 24 February." She said that a team from Fujitsu and Cerner were now working daily at the trust to resolve the problems being experienced. "Progress in tackling and overcoming the problems which have arisen, the majority of which have already been resolved, is being monitored daily." The minister added that the senior deployment manager for the south of England from the Department of Health agency Connecting for Health is currently being "stationed permanently on site to ensure the work of the Fujitsu/Cerner team is completed to the satisfaction of the trust", and managed through to resolution. . . Problems with the Millennium system have also been reported at earlier NHS sites in the south, particularly at the Nuffield Orthopaedic Centre. The next site due to go live in the South is understood to be East Sussex. No sites have yet gone live with Cerner delivered by BT in London."

Trust hits records trouble despite assurances to MPs (24 Apr 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/04/24/223397/trust-hits-records-trouble-despite-assurances-to-mps.htm

"The Department of Health has given MPs on the Public Accounts Committee an assurance that problems following a troubled go-live of nationally-bought systems at an Oxfordshire hospital will not be repeated elsewhere in the NHS. However, evidence has emerged that some of the same problems experienced at Nuffield Orthopaedic Centre have already occurred at Buckinghamshire Hospitals NHS Trust, which went live with the same version of the Cerner Millennium Care Records Service as Nuffield. . . Anne Eden, chief executive of Buckinghamshire Hospitals NHS Trust, said in a letter to Computer Weekly that reporting was an issue. She said, "All trusts need to provide reports on areas such as in�patient, outpatient, day-case activity, etc to our funding primary care trust. In addition, we can use this information to monitor and learn from our own performance." She added that there were "some difficulties in completing some aspects of reporting". This evidence raises questions about the assurances given by the Department of Health. The Care Records Service is the main part of the NPfIT. The aim is to give 50 million people in England a medical record that can be made available to any authorised clinician."

NHS computer hit by fresh glitch (8 May 2007)

BBC News

http://news.bbc.co.uk/1/hi/england/manchester/6633973.stm

"Hundreds of inaccurate patient records have been created every day because of a fault on the new NHS computer system. The problem - affecting patients in Greater Manchester with appointments booked via the online system - arose after a software upgrade. NHS Connecting for Health, which is overseeing the IT upgrade, said the fault would not affect patient care. The nationwide programme has been hit by problems and has been criticised by MPs, who warned it could cost £12.4bn. A spokesman for NHS Connecting for Health said the problem was expected to be fixed in the next few weeks. He said: "Although comprehensive testing is undertaken prior to the upgrades taking place, it is not unusual for these kinds of upgrades to identify teething problems in the early stages following implementation. We estimate that around 400 duplicate patient records might have been created each day. However, the system is being continually monitored throughout each day and where a duplicate is identified data is being merged to form one single record for each patient." Before the fault is fixed permanently, an interim solution has been put in place to identify the duplicate records and correct them, the spokesman added. "This has now been put in place with the full agreement of those organisations affected and will have minimal impact on the users of the system and no impact on the delivery of patient care," he said. Among the places affected by the problem are the University Hospital of South Manchester Foundation Trust and PCT Clinical Assessment Centres in Greater Manchester. . ."

CSC 'learnt' from Maidstone datacentre crash (7 Jun 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/06/07/224580/csc-learnt-from-maidstone-datacentre-crash.htm

"Guy Hains, the president of Computer Sciences Corporation's Europe Group, has spoken of the causes and lessons learned from a crash at the company's Maidstone datacentre last year. The crash caused a loss of systems for NHS trusts on an unprecedented scale. About 80 NHS trusts lost the use of some of their main IT systems for several days. "I believe that the biggest risk in the computer industry generally at the moment is unreliable power supply. Generally across the world power has become more spiky which is ruinous to any sort of IT system,” Hains told a Health Committee inquiry into aspects of the NHS's National Programme for IT [NPfIT]: CSC ran into difficulties after power problems caused a short circuit which damaged a storage device. The firm had to bring experts over from Japan to fix the problem. "We transferred the operation between our Maidstone centre and the reserve centre which was effected without data loss, as was the pass back to the primary data site some weeks later. We learnt several things from that. "First, we learnt that as we scale up the system it is better to have four centres than two, which is what we have invested in, so that data is now not only mirrored but effectively held simultaneously in two places. Second, out of that experience with the authority we have tightened our targets and expectations of how quickly systems need to be brought up,” he said. Under the new plans, the expectation is that key systems are back on line within 24 hours, rather than 72 hours previously. Other more critical systems are back online sooner."

A very, very long NHS appointment waiting list (30 Jul 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/07/30/225875/downtime-nhs-it-richard-dawkins-youtube-electioneering.htm

"Downtime has long suspected that the NHS IT programme may be rather unfairly picked on - it is, after all, a fairly sizeable project and a few things are always bound to go wrong. However, a letter from a reader may have forced us to change our mind. Said reader was trying to book a hospital appointment using Choose and Book, but came up against a bit of trouble in that he could neither choose, nor book. After being offered no appointment slots, one month, three months, or even a year ahead, our intrepid reader searched for appointment slots up to 2056. "When that came back empty I had a slight suspicion that something might be wrong," writes our reader. "Realising that they had not quite mastered web services, I gave the phone number a try. I was then informed that because I had recently used the online system, the adviser at the NHS was locked out of their system for half an hour! I tried back an hour later, only to be told that they had the same problem as me - ie. no free appointments from now until eternity. So now my details will be sent to the hospital, which will contact me directly (by phone) to arrange an appointment. Technology - don't you just love it!" Indeed."

Massive inaccuracies mar GP patient choice website (9 Aug 2007)

Health Service Journal

http://www.hsj.co.uk/healthservicejournal/pages/070809/N1/choices/p8

"Primary care trusts and GP practices will be asked to correct widespread mistakes on the Department of Health's flagship NHS Choices website. Half of the website's information on GP opening hours and a third of practitioners' names are thought to be incorrect, HSJ can reveal. The Information Centre for health and social care made the estimate after a survey of 4,500 practices showed wide variations in data quality on the site, run by Dr Foster Intelligence. . ."

NHS IT led to 'disturbing' incidents, says patient head (1 Oct 2007)

Computer Weekly

http://www.computerweekly.com/Articles/2007/10/01/227096/nhs-it-led-to-disturbing-incidents-says-patient-head.htm

"The head of a patient group at the first NHS trust in London to go live with the BT-supplied Cerner patient administration systems as part of the national IT scheme, has warned that trusts will receive complaints from patients when they go live with similar technology. Alex Nunes, chair of the Patient and Public Involvement Forum for Barnet and Chase Farm Hospitals NHS Trust, said there had been "disturbing" incidents after the trust went live with new systems under the NHS National Programme for IT (NPfIT). . . Nunes said that the hospital had sent letters to some people asking them to come in for operations when they did not know anything was wrong, and others who were expecting to be invited for appointments did not receive letters. Nunes said he did not blame the trust for the difficulties, and he fully supported the NPfIT, which he said was a courageous plan that could lead to a "tremendous improvement" in the care and treatment of patients. But he warned that with troubled implementations "there is a danger of taking one step forwards and two steps backwards". Barnet and Chase Farm Hospitals went live in July with the R0 release of software from US healthcare specialist Cerner. It was the first implementation by BT in London of Cerner's Millennium system under the NPfIT. Diabetes patient, Fred Ciccone, told his local newspaper he felt like a ghost after staff were unable to access his medical records on a visit to Edgware Community Hospital. Remon Gazal, then director of IT at the trust, did not underplay the difficulties for some patients. He said that there have been some significant improvements as a result of the go-live, and workarounds have been developed for defects that have an operational impact. The trust's suppliers had made no comment as Computer Weekly went to press."

Spine to be shut for two day 'refresh' (1 Nov 2007)

e-Health Insider Primary Care

http://www.ehiprimarycare.com/news/3176/spine_to_be_shut_for_two_day_'refresh'

"Connecting for Health (CfH) and BT have confirmed that the NHS Spine will be unavailable when it is taken down for a major upgrade from next Friday evening until Sunday morning (9-11 November). The Department of Health agency describes the refresh of software and hardware as 'unusual' and 'unlikely' to occur again in the future. A practice 'refresh' of the Spine has already been carried out as a dry run in a recent technical rehearsal. CfH is warning that the planned maintenance work will affect all NPfIT systems linked to the Spine, including: the Personal Demographic Service, Choose and Book and GP2GP. The agency said the upgrades did not represent a complete replacement of the Spine. "The exercise is solely an uplift of the database management hardware and software. The application code and functionality of the Spine remain unchanged. The change will be transparent to users," said a spokesperson. . . Choose and Book will face major disruption during the planned maintenance for all users. Over the weekend of 10-11 November, clinicians and patients will not be able to view, make, change or cancel an appointment using the Choose and Book service. There will be no access to the Directory of Services and callers to the Choose and Book appointments line will only be able to have discussions about choice. CfH has advised clinics operating during this time to print patient referral information for the 36-hours downtime in advance. GP practices using the GP2GP service to transfer records will not be able to send or receive information from 2200 on Thursday 8 November to 1000 Sunday 11 November 2007, allowing for the 24 hours transfer completion time. It will not be possible to issue prescriptions with barcodes on them, so pharmacy dispensers will have to manually input prescription items into their systems. In addition, updates to patient demographic data will not be saved on the Personal Demographic Service during the downtime. . ."

Transplant patient has NEW kidney removed after NHS computer blunder (20 Jan 2008)

Daily Mail

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=509289&in_page_id=1770&in_page_id=1770&expand=true#StartComments

"A kidney transplant patient was forced to have the new organ removed, when it was discovered that the incorrect blood type had been recorded. A kidney transplant patient was forced to have the new organ removed after just a few hours - when it was discovered that the patient's blood type had been incorrectly recorded on a computer database. The mistake, believed to be the first of its kind in Britain, would have led to the organ being rejected - with possibly fatal consequences. The incident, which was only revealed in response to a Freedom of Information request, comes just days after Gordon Brown called for a system in which individuals are presumed to consent to the use of their organs for transplant unless they specifically stipulate otherwise. The error will intensify demands for fresh safeguards. And it will inevitably raise further fears about a planned NHS supercomputer, or centralised 'spine', on which all medical records will be held. The problems began when staff at the Royal Liverpool and Broadgreen University Hospitals Trust wrongly recorded the patient's blood type as A positive and sent it to the computerised national transplant database. This happened despite the fact that the correct blood type, O positive, was entered clearly on the hospital's paper records. The Government-run body which manages the database, UK Transplant, then sent out a kidney compatible with an A-positive patient, which was transplanted. The error, which was overlooked by a series of NHS workers including nurses, surgeons and transplant co-ordinators, was picked up only when a data-entry clerk at the hospital checked the patient's notes against the computer record after the operation. Further checks revealed that a second renal patient had also been registered with the wrong blood group. . . The blunder took place three years ago and would have remained secret had The Mail on Sunday not seen a confidential report into the "profound error". The internal investigation did not name the hospital involved. But of the three hospitals managed by the Trust, only the Royal Liverpool University Hospital has a transplant unit. The report concluded that the initial data entry mistake was "human error" but said "there was no means of identifying" who did it, or where the incorrect information had been entered. Although the mistake was made by Hospital Trust staff, the report blamed UK Transplant for failing to set up a standard nationwide system for entering patient details. . ."

Healthcare at your fingertips - a Choose & Book roadtest (18 Feb 2008)

The Inquirer

http://www.theregister.co.uk/2008/02/18/choosenbook_review/

"NHS IT - money, well, spent. . ." [There follows a detailed account of fruitless attempts to use Choose and Book.]

UK government data protection is a shambles (10 Mar 2008)

The Register

http://www.theregister.co.uk/2008/03/10/uk_gov_data_protection_shambles/

"The UK Government has failed to put in place basic data protection and integrity policies despite recent major information breaches, according to an online ID firm. Responses to Freedom of Information requests by online identity firm Garlik reveal that all 14 of the government departments that responded lack basic systems for proving compliance with the Data Protection Act (DPA). Garlik sells services that allows consumers to identify what personal information about them is in the public domain and manage how their identities appear online. The DPA states that an organisation needs to act if someone tells it the information it holds on them is inaccurate. But only the House of Lords and the Serious Fraud Office maintained a written data correction policy or protocol. Even these government bodies failed to maintain regular independent audits. . . With the national identity register and huge NHS databases on the horizon, the public can have little confidence that data held about them by the government is correct. As a result, important decisions affecting their lives may be based on erroneous information, Garlik warns. Large scale databases typically have an error rate of between five and ten per cent, Garlik said, so a government database containing 10 million records might have between 500,000 and one million errors. Garlik is calling on the government to pull up its socks by establishing written policies and procedures for monitoring the accuracy of information and correcting erroneous database entries. It also wants government departments to publish reports based on periodic independent audits."

Barts NHS NPfIT go-live ends up in "The Sun" (10 Apr 2008)

Computer Weekly - Tony Collins IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2008/04/barts-npfit-golive-ends-up-in.html

"Barts and the London NHS trust has ended up in "The Sun" newspaper yesterday [9 April 2008] after going live with a basic version of Cerner's "Millennium" Care Records Service under the NHS's London Programme for IT. The newspaper claimed that "two top hospitals descended into chaos last night as a multimillion pound computer scheme crashed on launch day" . It said the system should hold all patient records and bookings of operations, but it "failed, forcing doctors at the Royal London and Barts hospitals in East London to write notes on slips of paper." Responding to story, Barts and The London NHS Trust issued a statement which denied the system had crashed but made no comment on The Sun's claim that doctors had resorted to writing notes on slips of paper. The trust's statement gave the impression of minor problems only, saying the "majority" of issues had been resolved within 24 hours. It apologised to patients for a "slight delay" while staff familiarised themselves with the systems. . ."

Choose and Book glitch gives patients wrong appointments (22 April 2008)

Onmedica

http://www.onmedica.com/NewsArticle.aspx?id=d90d1db7-4c4d-4a3b-bfe1-0c1a574ebf7a

"Hundreds of patients have been given the wrong appointment through Choose and Book, Connecting for Health has confirmed. A glitch in the software has meant that some patients were given other patients' appointments � so they received the wrong time at the wrong clinic and with the wrong consultant. The problem has meant that Connecting for Health has been forced to delay the release of updated Choose and Book software (release 4.0). . ."

Spine problems force trusts to switch off CRS (2 Jun 2008)

e-health Insider Primary Care

http://www.ehiprimarycare.com/news/3807/spine_problems_force_trusts_to_switch_off_crs

"Trusts across England were forced to switch off their connection to the Personal Demographics Service, after a weekend upgrade led to the system suffering from 'intermittent problems' leading some to stop using their electronic record systems. The weekend upgrade, called Spine release 2008-A, was a major upgrade to the Spine PDS service. The PDS is the national NHS spine service, which forms the core of the NHS Care Records Service - underpinning basic patient administration and the creation of electronic care records. An NHS Connecting for Health spokesperson said the Spine was upgraded over the weekend of 30 May - 1 June, with a number of problems identified and fixed over the weekend. However on Monday morning further issues arose with the PDS. "These problems were investigated by NHS CFH and BT, the supplier of the Spine service, and have now also been resolved." Several trusts today told E-Health Insider the upgrade led to a series of glitches, which made using patient administration systems - supplied as the first stage of a CRS - difficult to use over the weekend. Some trusts have had to switch off patient record systems as a result. Three NHS trusts in the North Midlands and Eastern Programme for IT, live with the iSoft iPM patient administration system, said the system proved difficult to use during the upgrade, and they were forced to switch it off until they received assurances from NHS Connecting for Health it was 'fit for purpose.' . . ."

Winchester has four-day Millennium failure (12 Jun 2008)

e-Health Insider

http://www.e-health-insider.com/news/3844/winchester_has_four-day_millennium_failure

"Winchester and Eastleigh Healthcare NHS Trust, has in the past week suffered a four day problem with its Cerner Millennium Care Records System (CRS) that left it unavailable to some users for up to four days. The problems began on Thursday, 5 June, and though largely resolved by Sunday were not fully fixed until Monday, 9 June. While the system was unavailable the trust reverted to manual paper systems. Enquiries by EHI revealed that support to get the system running again was supplied by Fujitsu. In a prescient June board paper the trust identified uncertainty over support arrangements as a result of Fujitsu ceasing to be LSP as a critical 'red' strategic risk to the trust. The paper says the trust is, Working with SHA and SPfIT to ensure full maintenance contracts are in place and agree an escalation process in the event of a system failure..." Shortly afterwards Winchester become the first trust in the south to have to put the interim support arrangements for its Millennium system to the test, since Fujitsu who installed the software had its regional local service provider contract (LSP) ended. There has been a recent track record of problems with the centralised hosting of the software. In May alone there were two instances of region wide problems, resulting in the Millennium system becoming unavailable or very slow to access. . ."

NHS IT mess hits cancer patients (27 Jun 2008)

BBC News

http://news.bbc.co.uk/1/hi/health/7477099.stm

"Patients with suspected cancer have had urgent appointments postponed at a top London hospital because of problems with the new NHS computer system. It is one of a series of problems faced by Barts and The London NHS Trust since the IT system went live in April, according to Computer Weekly magazine. Other issues include patients being booked into closed clinics and repeatedly cancelled appointments. A spokesperson for the Trust said there had been no clinical harm to patients. A total of 11 patients with cancer have had urgent appointments postponed for between two days and a month - the government target states that every patient with suspected cancer should be seen within two weeks. . . Members of the board also heard that the hospital is not receiving any money for treating patients because the records of what work has been done are not reliable. There are also problems with meeting the four-hour wait target for seeing emergency patients because staff are struggling with the new system. The Millennium software system used at the Trust was provided by Cerner for British Telecom who are charged with upgrading IT in the London region. . ."

Chaos as £13bn NHS computer system falters (10 Aug 2008)

The Observer

http://www.guardian.co.uk/society/2008/aug/10/nhs.computersystem

"A £13bn overhaul of the NHS records system has suffered so many problems that hospitals have struggled to keep track of people requiring operations, patients with suspected MRSA and potential cancer sufferers needing urgent consultations. Glitches in the roll-out of the Connecting for Health computer system have also resulted in delays at accident and emergency departments, soaring complaints and failures to identify child-abuse victims. The revelations are just the latest setback for what the government has pledged will be a key factor in improving NHS services. According to the board minutes of the first London NHS trusts to install the new system, obtained by The Observer and Computer Weekly, it has had a serious effect on patient care, a problem that raises questions about its introduction to hundreds of other hospitals and trusts. A report to the Enfield Primary Care Trust in March reveals that difficulties with the system last year meant it did not have vital data identifying patients awaiting operations. As a result 63 patients of the Barnet and Chase Farm Hospitals NHS trust had their operations delayed. In April, the trust found that the system had failed to flag up possible child-abuse victims entering hospital to key staff, 'leaving the responsibility to the receptionist'. The same trust noted the following month that 272 elective operations were cancelled at the last minute for 'non-clinical reasons' and that 20 patients were not readmitted for treatment within 28 days at the end of last year because the 'surveillance system for tracking' them 'was not operational in the new ... system'. The board's minutes show 14,000 people contacted the trust last year with concerns about their treatment, compared with 5,500 in 2006. A report to the board of another NHS trust, Barts and the London, says that for six months to May this year the trust failed to meet targets for treating emergency patients within four hours, chiefly because staff were unfamiliar with the new computer system. The same report reveals that in May there were 'breaches of the two-week urgent cancer access guarantee' for the same reasons. As a result 11 patients who were suspected of having cancer did not receive consultations on time. According to minutes presented to the Buckinghamshire Hospitals NHS Trust, problems with the new system last year meant potentially infectious patients with MRSA were not isolated for up to 17 days. The problem had to be rectified manually by staff who updated the patient records themselves. 'This took approximately six weeks to do, during which time there was a possibility that some MRSA-positive patients may have slipped through undetected if medical notes had not been available,' according to the report. The revelations have prompted claims that the government is losing control of the flagship project. 'IT projects well implemented can be a huge benefit,' said Stephen O'Brien, the Conservatives' health spokesman. 'Clearly from the problems being encountered by many trusts, the benefits are not being achieved and all the risks are falling on patients.' Many trusts have delayed implementing the new system as a result of the problems and the chief executive of Connecting for Health, Richard Granger, resigned last year. Those trusts that have implemented the system complain it diverts staff from key duties. A report last month to the board of the Royal Free Hampstead NHS Trust said 12,000 patient records had to be manually amended over a three-week period. . ."

Patients 'at risk' from flawed £12bn IT system (5 Oct 2008)

Sunday Times

http://www.timesonline.co.uk/tol/news/uk/health/article4882792.ece

"An NHS computer system intended to revolutionise patient care has so many software flaws that seriously ill or badly injured patients are at risk of being inaccurately diagnosed, according to an internal health service document. An assessment of the system at the first hospital to launch it, the Royal Free Hampstead NHS Trust in north London, details a catalogue of software glitches and design faults. It warns that the problems pose a possible "risk to patients by underestimation of clinical condition". According to the document, the system, which is being used in the accident and emergency department, is routinely crashing, patient information is intermittently "lost" and some staff are reverting to pen and paper. Extra staff have been drafted in to help cope. Tony Collins, executive editor of Computer Weekly, said the document, disclosed by an NHS employee, warned that some of the problems could "continue indefinitely". He said: "This is the centrepiece of the Connecting for Health programme [the government's plan to computerise NHS records] and it isn't working properly." Hospital officials said this weekend that continuing problems were being "vigorously" pursued with the contractors while staff were being vigilant to ensure patient safety was not compromised. The report is the latest setback for the £12 billion Connecting for Health programme, which was meant to provide a single nationwide IT system for the NHS containing records for every patient by 2010. While some elements of the programme have been introduced ahead of schedule, the patient record system has been beset with delays and software problems. Last June the Royal Free became the first trust to launch the most advanced version. To protect patient confidentiality, records can be accessed only with a swipe card and a code. The launch was a key test for Connecting for Health, which has faced questions about the reliability of its systems and whether patient confidentiality could be easily compromised with computerised records. Two months after the launch there were reports of missing data and delays in booking patient appointments. Now an assessment of the new system at the Royal Free has uncovered a series of problems, which appear to be unlikely to be fixed in the short term. The Royal Free Hampstead NHS Trust said the implementation of the new system was initially better than expected but there were continuing problems that would "take some time" to rectify."

London hospital trust loses £7.2m in upgrade debacle (6 Nov 2008)

ComputerWorldUK

http://www.computerworlduk.com/management/government-law/public-sector/news/index.cfm?newsid=11850

More NHS computer trouble as BT installs Cerner system. The Royal Free Hospital in London has los £7.2 million over six months as a result of its implementation of new Cerner-based IT systems. Details of the loss, around six percent of the budget, were outlined in a half yearly review presented to Royal Free board last month. Hospital chiefs were given details of the additional costs and lost opportunities to treat patients - and hence get paid - incurred during deployment of the system by BT. The report stated that the new system did not properly support the trust's "patient pathway". This meant "many clinical and admissions slots were not used". It highlighted incorrect and missing data on the new system. This was "in part due to the clunky workflows and, in part to the lack of experience of our staff in using the actual Royal Free build," the board was told. Trust leaders heard that: "The system supplied was different to the system supplied for training, and there were no operating procedure manuals for the system." Additional staff were required to rectify data issues and to "maintain normal activity levels", at a cost of £1.2 million. Finally, problems with the stability of the system were reflected in declining levels of clinical efficiency, which the Royal Free estimates cost it £900,000. The LC1 system, which went live at the Royal Free in August, is London's first version of Cerner Millennium, is one of two key records systems being rolled out across the UK under the National Programme for IT in the NHS (NPfIT). It links directly into the NHS spine, which is the central database for digital records of patients. Responding to staff complaint about "chaos" after the new system went live, the Royal Free said, reports of major problems were exaggerated and that it was "certainly not correct" to call the situation chaotic. "A new system of this size and complexity inevitably meant a few teething problems and that staff had to get used to new ways of working and new processes," the trust said in a statement. "The implementation of the system involved training 4,000 staff and months of preparation."

Patients 'sent to wrong hospital' (2 Feb 2009)

The Times

http://business.timesonline.co.uk/tol/business/industry_sectors/technology/article5636729.ece

Patients going to see Dr Paul Thornton, a GP in Kingsbury, Warwickshire, were told that his new computer system would allow them to be referred to a consultant in a matter of seconds. There would be no more need to wait while he wrote letters to hospitals, which took weeks to process. Arrangements for their treatment could be made online in a few clicks, while they watched. But the technology, the NHS's new Choose and Book system, was slow and clunky and crashed frequently, Dr Thornton said. He complained to the agency running the NHS programme, Connecting for Health, and was given an interim system that did not work much better. In the interim system, he said: "We had to enter the patient's details and the system would give you a username and a password which we would give to the patient. They went away and rang a helpdesk which would sort out a hospital appointment. The trouble was that the patients were being diverted to hospitals which were not appropriate. Some were sent to departments 50 miles away." That system prevented GPs from matching patients to individual consultants. "It took away the personal quality of the process," he said. "It failed to take into account that we look for consultants who will be able to respond to the individual patient." Within three months he stopped using the system, as had others, he said. New technology was crucial, "but they have got to get it right". Not all NHS professionals dislike the new technology. Simon Eccles, an A&E consultant at Homerton Hospital, East London, uses BT's Cerner Millennium to order tests and book appointments. "I work in a fast-moving environment and the system allows us to see exactly what's happening with every patient," he said. "It's fantastic."

NHS severe computer faults double (3 Feb 2009)

e-Health Insider Primary Care

http://www.ehiprimarycare.com/news/4538/nhs_severe_computer_faults_double

NHS Connecting for Health, the health service's IT agency, has revealed that the number of severe faults in NHS computer systems has doubled over the past three years. Last year nationwide NHS computer systems suffered 820 severity-one or critical faults with national applications, provided by National Application Service Providers (NASPs) the majority relating to the N3 network. In 2006 the figure stood at 488. According to the Department of Health over 91% of NASP severity one incidents relate to the NHS national broadband network (N3). NHS CfH defines a severity one NASP fault as a problem affecting a system critical to patient care or affecting 5,000 NHS computer users or more. In addition the service suffered 1,850 severity two failures in 2008. Figures for severe reported faults with local service provider (LSP) systems have meanwhile declined from 349 in 2006 to 262 in 2008. The number of level two LSP faults has remained at around the 1100 mark for each of the past three years. The DH said that the figures related to reported problems and were not a reflection of system performance. "In practice and after investigation, many incidents are found to be local hardware, software or infrastructure problems, or they are re-categorised with the agreement of the user". The figures were revealed in a written parliamentary answer to Liberal Democrat MP Norman Lamb. In part the increased number of NASP faults is likely to relate to wider user of enterprise-wide IT systems within the NHS, as a result of the roll-out of parts of the £12.7bn National Programme for IT (NPfIT). Better reporting mechanisms, with specified service levels in contracts, may also be a factor. In October 2008 the number of critical faults in national IT systems jumped to 165, from 71 the previous month - a spike CfH attributed to "a set of issues affecting two systems". According to a ZDNet report the agency said the two unspecified problems had a "noticeable effect" on a number of NHS computer users.

NHS boss attacks e-records system (13 Feb 2009)

BBC News

http://news.bbc.co.uk/1/hi/health/7887438.stm

"A new NHS computerised medical records system on trial at a London hospital has been criticised by a hospital boss for causing "heartache and hard work". Andrew Way, chief executive of London's Royal Free Hospital, said technical problems had cost the trust £10m and meant fewer patients could be seen. The Department of Health said lessons had been learnt from the trial. The England scheme, part of a £12bn IT upgrade, aims to put 50 million patient records on a secure database by 2014. The Royal Free, one of a number of early adopters of e-records, has been using the system since last summer. The project, restricted to England, has been one of the most controversial aspects of the overall 10-year IT programme, which also involves an online booking system, digital imaging for X-rays and electronic prescriptions. Mr Way said the cost of the problems had meant the hospital had been unable to invest in new equipment. He also said technical glitches had caused more work for staff and meant out-patients' bookings were taking four times as long. As a result, the hospital has had to employ another 40 administrative staff to handle the extra workload, he added. The faulty system had also prevented the hospital from billing other parts of the NHS for treatment. Mr Way said: "I think it is very disappointing that the work we had to do as a trust has caused our staff so much heart-ache and hard work. Many of the medical staff are incredibly disappointed with what we have got. I have personally apologised for the decision to implement the system before we were really clear about what we were going to receive. I had been led to believe it would all work." However, he said he still believed in the idea of replacing paper records with an electronic system, but it would need more work to get it right. . ."

Hospital abandons Care Record plans after rollout causes chaos (3 Mar 2009)

Pulse

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4122017&c=2

The rollout of the Summary Care Record has caused such chaos at A&E that the first hospital to gain access has had to abandon plans for routine use of the system, Pulse can reveal. A Connecting for Health document reveals use of electronic records at the Royal Bolton Hospital A&E department led to farcical scenes and long queues of patients because it was so slow. The ability for A&E to access patient information held by GPs was one of the main reasons for introduction of the care record. But the document released by Connecting for Health's Summary Care Record Advisory Group reveals Bolton hospital had to abandon plans to access records except on the specific request of doctors and even then by printing out hard copies. A benefits realisation study found care records had been accessed for just 24% of patients - because of delays in the system and 'low numbers of patients with SCRs'. The method for checking whether patients had records uploaded was 'cumbersome' and searching for and printing out a care record took staff an average of one minute. 'Queues occur for walk-in patients when there are any delays in the booking-in processes,' the report found. There were some benefits of the care record in A&E, particularly for patients with complex and acute problems, and also in the hospital's pharmacy, community and acute medical receiving units. An NHS Bolton spokesperson said a system upgrade next year would flag up when a care record had been uploaded, 'helping reduce access time'. He added that only a minority of patients in A&E would have a care record, since only a third of patients in Bolton had had information uploaded, and patients from other areas also used the hospital. Dr Darren Mansfield, GP clinical lead for urgent care at NHS Bolton, insisted the project was on track. 'The care record is starting to show its potential to dramatically improve the quality and safety of care we deliver to Bolton's patients,' he said. But GPs critical of the care record claimed the report showed the project was of limited value. Dr Mark McCartney, a GP in Pensilva, Cornwall, said: 'The evidence is beginning to suggest there is no benefit for the vast majority of patients attending A&E. For the small minority for whom there might be a benefit, other cheaper, more secure and acceptable systems could be developed, such as patient-held records.'

PACS - jewel of the £12.7bn NHS IT scheme? (9 Sep 2009)

Computer Weekly - Tony Collins IT Projects Blog

http://www.computerweekly.com/blogs/tony_collins/2009/09/pacs---the-saviour-of-the-127b.html

When Roger Conway, a company secretary, broke his arm at Bristol Airport, he came to understand that PACS x-ray systems cannot always talk to each other. Ministers, loyal Labour MPs and Whitehall health officials cite PACS [picture archiving and communication systems] as an example of the success of the £12.7bn National Programme for IT. But integrating PACS so that images and radiology notes can be exchanged between hospitals remains a problem. On a Sunday last month, Conway stepped into a gap between a ramp and bollards where alteration works were taking place at Bristol Airport. He was taken to Weston General Hospital, which is a pioneer of the NPfIT. It was one of the first hospitals in the south of England to install the Cerner Millennium system as part of the NHS IT scheme. It also installed a PACS system in 2006. Doctors and nurses were understandably enthusiastic, according to the hospital's publicity. To Conway, PACS has some way to go before it'll earn his admiration. He ended up having the same x-rays done twice because Weston General Hospital did not transfer the PACS images it had taken of his broken arm to his local hospital about 30 miles away in Taunton. His local Musgrove Park Hospital in Taunton is in the in the same county as Weston - Somerset - and the two hospitals are controlled by the same PCT. But PACS images are not routinely transferred between the two hospitals. Conway says that Weston was unable to put an electronic copy of his x-rays on a CD which he could take with him to Musgrove. Weston's staff had suggested to him that Musgrove would be able to access the radiology notes the next day. This proved incorrect and even an email with the x-rays attached was refused. He was told that Weston and Musgrove's PACS systems were incompatible. Today Conway could be forgiven for saying that if PACS is the main success of the NPfIT where does this leave the rest of the £13bn programme? . . . There's no doubt that PACS has been a boon to Weston. Its efficiency brought down waiting times for x-rays, images don't get lost, there's no need for storage space for films, radiology staff don't need to touch the dangerous chemicals they previously used for processing films, and patients don't have to wait for, and carry around with them, packets of x-rays. Diagnoses are made more quickly and the working space is more spacious and airy. Clinicians can manipulate areas of the image normally lost to under or over exposure. But ... One of the promises made for PACS in 2001, when it began to be installed by hospitals in earnest [before the NPfIT which was launched in 2002] was that images could be transferred to other hospitals, peripheral clinics, GPs and the homes of doctors, at least in a compressed format. Eight years after the promises, this sharing of PACS images has yet to become a widespread practice. In 2001 the sharing of PACS images was being promised even over dial-up modems. Now the NHS has a data spine and broadband. In March this year, according to E-Health Insider, a report of the Royal College of Radiologists said that PACS systems in England are largely successful in individual hospitals but communication between systems in different hospitals is poor. . .

IT causes 14,000 NHS patient waiting list backlog (1 Oct 2009)

Computer Weekly

http://www.computerweekly.com/Articles/2009/10/01/237934/it-causes-14000-nhs-patient-waiting-list-backlog.htm

IT problems at one of UK's most respected hospital trusts has led to a backlog of at least 14,000 London patients on a waiting list for treatment. The backlog affects patients at St Bartholomew's (Barts) Hospital and The London NHS Trust, which serves two million people in east London, the City, and Canary Wharf. Barts, which describes itself as world renowned, has 22,000 electronic patient records on its waiting list of people who should be treated within the national target of 18 weeks. Many are duplicates, but at least 14,000 are considered by trust staff to be the records of individual patients. The trust says dealing with the backlog may mean some patients end up waiting more than 26 weeks for an operation, in breach of government targets. Doctors say there are inaccuracies in data, the system can be slow and staff do not always understand the work-arounds, and the way the system works in combination with the trust's practices. They add that, unless they fully understand the system's characteristics, they may find the data hasn't gone to the right place for the patient to be treated. Barts and The London NHS Trust told Computer Weekly: "It has been a frustration for everyone at Barts and The London NHS Trust that our desire to meet the 18-week national target has been compromised by previous weaknesses in our information management and administration systems. The Trust has no evidence, however, that any patient has come to clinical harm because of the backlog." Since installing the Cerner Millennium Care Records Service in 2008, as part of the NHS's National Programme for IT (NPfIT), staff and doctors at Barts and The London NHS Trust have lost track of thousands of patients on its waiting lists. Some in the NHS are surprised the IT problems at Barts have continued for nearly 18 months. In June 2008, Barts said: "the outstanding issues resulting from the implementation of Care Records Service are in the process of being resolved". Barts' 18-week waiting list backlog reached 26,640 in August. This had been cut to 22,000 patient cases by the end of last week. From these 22,000 staff and doctors are unable yet to tell which patients have had treatment within the government's 18-week standard. The main health authority in the capital, NHS London, said in a statement to Computer Weekly: "Barts and the London are working to address a potential backlog of around 23,000 patient records to determine those who have been treated within 18 weeks and those who have breached this standard." The strategic health authority is meeting monthly with the Trust and its commissioning PCT to ensure that this backlog is addressed." Computer Weekly has also learned that Mike O'Brien, the health minister responsible for the NPfIT and the 18-week standard, is receiving fortnightly reports on the efforts at Barts and The London to reduce the backlog. The problems at Barts - and at other London hospitals which run the Cerner Millennium Care Records Service - could undermine a decision to resume a roll-out of the NPfIT system after a halt last October. The next hospital in line for the system is Kingston Hospital NHS Trust. The Department of Health's website says nobody should wait more than 18 weeks for the start of their treatment, from the time they are referred by a GP, unless they choose to wait longer or it is clinically appropriate to wait longer.

NHS IT pioneers see risks of over-optimism materialise (5 Oct 2009)

Computer Weekly

http://www.computerweekly.com/Articles/2009/10/05/237989/nhs-it-pioneers-see-risks-of-over-optimism-materialise.htm

When a group of pioneering hospitals in London went live with a major e-records system under the government's £12.7bn NHS IT scheme, a headline in The Sun set the scene for the next 18 months. "Data Woe at 2 London Hospitals," it said, pointing out that doctors had been forced to write notes on slips of paper when a new Care Records Service system crashed. Barts and The London NHS Trust and BT, the main IT contractor for London under the National Programme for IT (NPfIT), denied the story. The trust said, "The new patient administration system - also known as the Care Record Service (CRS) - did not crash A period of adjustment was anticipated with contingencies in place to support staff who experienced any problems, with the majority of issues being resolved within 24 hours." The statement proved optimistic. Difficulties at the trust have escalated, almost month by month, since the Care Records Service system went live in April last year. Backlogs of patients who were not seen or treated within government waiting-time standards grew at first to hundreds. Now, 18 months after the go-live, Computer Weekly has revealed that at least 14,000 patients are on a backlog for treatment. Barts has lost track of their appointments - though the system was installed to keep track of the healthcare "pathways" of patients. No one should wait more than 18 weeks for treatment after being referred by a GP, under government guidelines. But hospital executives have no idea how many of the 14,000 patients are outside of the 18-week limit. Doctors at the hospital made electronic requests for their patients to be treated, but found much later, or never discovered at all, that the appointments had not been made. Doctors or their staff pressed the wrong keys, or the requests did not end up at the expected destination, or both. Data already in the system was inaccurate and some doctors found the technology was not always simple to use, or did what they expected. Most worryingly, nobody seems clear on what has caused the chaos. Since August things have got a little better. The 18-week backlog has come down from 26,640 to about 22,000. Some of the 22,000 on the list comprise duplicate records, but at least 14,000 are thought to represent actual patients. The trust's board hopes things will be back to normal by December. But the trust has been hoping since April 2008 that a return to normality was around the corner. It is difficult not to feel sympathy for Barts' IT specialists, doctors and administrative staff. The decision to go live was taken at a higher level, amid a ministerial imperative for the NHS to show that the NPfIT was delivering. London officials wanted to show that the capital could deliver. But they may have fallen victim to the "irrational exuberance" which afflicts large IT projects. Today the political pressure for the NHS to install the Cerner Millennium Care Records Service throughout London is as strong as ever. Ministers and officials hope that a succession of successful launches will throw a warm light over the NPfIT. The Care Records Service programme is running four to five years behind schedule, according to the Public Accounts Committee. Ministers want to catch up. So officials in London have announced plans to resume a roll out of the Cerner system. They say that the lessons from Barts and other sites have been learnt. But going live elsewhere before anything has been published on what exactly has caused the problems at Barts may be a further demonstration of unwarranted optimism. Ross Anderson, professor in security engineering at the University of Cambridge, said, "Hospital managers have good reason to ask why they are ordered to put in systems that are not fit for purpose and are then punished for not meeting targets when there has been a balls-up." Politics has plunged some hospitals, particularly Barts, into administrative and operational turmoil in the name of the NPfIT. It will be a pity for patients if politics continues to dictate the roll out of the programme.

The chaos of the NHS's electronic records (14 Dec 2009)

Daily Telegraph

http://www.telegraph.co.uk/health/healthadvice/maxpemberton/6787809/The-chaos-of-the-NHSs-electronic-records.html

"What's his name?" I asked. The nurse in A&E shook her head. "His address?" Again, nothing. "OK, do we know anything about him?" The nurse shrugged - not a thing. The mystery man had been brought in by police after he was found stumbling and acting strangely in the street. He was unable to talk and had no wallet or identifying documents on him. Although he was not wearing shoes, he looked quite well dressed and was obviously not living on the streets. At first we thought he must be drunk, but he didn't smell of alcohol and after several hours in A&E there had been no change in his presentation. "He must have come from somewhere," I said, while the police checked for missing persons. All our attempts to find his identity drew a blank. One of the nurses persevered and he managed to tell them his name. With this information, we looked him up on the new, super-duper NHS electronic records. There he was! Bingo! But what was it we were hoping to find out? We looked at his address and then got back to doing blood tests and a scan and ensuring he was stable. In such an acute setting, finding out where someone lives, that he has an ingrowing toenail or that he's allergic to peanuts is not really the priority. When someone is brought in unconscious or unable to speak or give any history, the priority for the medical staff is to ensure they are physiologically stable - that they are breathing, their heart is beating and their blood pressure is adequate. While background details are important, these are rarely the pressing concern when someone is in extremis. Yet the Government has repeatedly justified the ludicrously expensive NHS IT programme on the grounds that it is needed in precisely this situation. The reality is, it's not. Not only this, despite vast sums being spent, the system is not fit for purpose. Aside from the issues around confidentiality and the Government's refusal to allow people to opt out from having their personal details entered into the system, the whole thing has proved to be an ill-thought out, wasteful and unnecessary white elephant. Different trusts have different IT systems locally, and social services have different electronic records altogether. Mental health records are on different systems to GP records, which in turn are entirely different to the records kept in hospitals. Chaotic would be an understatement. As these systems have been developed independently and adopted piecemeal, there is no meaningful communication between them. There is no guarantee that you will find the information you are looking for. There are duplicate entries; details are wrong or out of date. Not only this, but now that hospitals have moved away from paper-based records, wards have had to be provided with laptops, and everything must now be typed. Systems crash, work is lost, hardware is lost or stolen, or breaks. Of course, rolling out IT programmes costs money in itself - staff have to be trained, support staff employed, and space found for training centres. In the pre-Budget report last week, Alistair Darling announced that the National Programme for IT will be scaled back. The cost of this programme has already spiraled to more than £12 billion. This is one NHS cutback that I wholeheartedly welcome, but I wish that it had happened before so much money had already been spent. Most doctors and nurses I know are only too well aware of the impact of wasteful, unnecessary spending in the current economic climate. We are only too aware that if some non-essential things are not sacrificed now, then cuts in the future may have to impact on patient's welfare. None of us want that. We want the NHS to be lean, focused and financially robust. As much as IT professionals would like to tell us otherwise, a computer programme does not save your life. It doesn't check your feet when you've got diabetes or plaster your leg when you fall over. It doesn't operate on your hip or turn you when you've had a stroke. As the NHS IT programme has shown, if anything, it can actually hinder clinical practice. We eventually stablised the mystery man and diagnosed a rare type of withdrawal from alcohol. Up on the ward he began to speak and told us his personal details himself. The address we had for him was wrong; he'd recently moved. I'd expect something better for £12 billion.

Newcastle expands use of Millennium (17 Dec 2009)

E-Health Insider

http://www.e-health-insider.com/comment_and_analysis/545/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. . . 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. . . 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. . . 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. . . . 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. . . Royal Berkshire NHS Foundation Trust and Wirral University Teaching Hospital NHS Foundation Trust are also due to take Millennium outside the national programme. . .

Over 1,000 NHS desktops part of botnet, says Symantec (23 Apr 2010)

ZDNet UK

http://www.zdnet.co.uk/news/security-threats/2010/04/23/over-1000-nhs-desktops-part-of-botnet-says-symantec-40088746/

Over a thousand UK health systems have been compromised and are part of a data-stealing botnet, according to security company Symantec. The 1,100 computers are infected with the Qakbot worm. This monitors compromised computers for information before uploading the data to Qakbot botnet command-and-control servers, said Symantec in a blog post on Thursday. Symantec has alerted the NHS about the compromised systems, said Cox, which came to light when the company began monitoring two command-and-control servers in March. These are FTP servers that are also infected machines and part of the botnet. Patient data is unlikely to have been stolen, Symantec security operations manager Orla Cox told ZDNet UK on Friday. "This is very much a consumer threat," said Cox. "Once it gets into a corporate environment, it looks for consumer data." Qakbot searches for information such as online banking details, credit card data, social-networking credentials and internet mail credentials, according to the Symantec blog post. It is theoretically possible for the botnet controllers to order the bot to download a new copy of itself that is equipped to steal patient data, but this would be unlikely, said Cox. "This is not a very targeted threat. It's not that sophisticated," she said. The NHS had not responded to a request for comment at the time of writing. However, ZDNet UK understands that the NHS is aware of the Symantec discoveries and is investigating the issue.

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