System Reliability and Performance
From Nhs It Info
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
“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.”
Major incidents hit NHS national systems (19 Sep 2006)
Computer Weekly
"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
"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."
