Millennium fug

Cerner Millennium has been back in the news in recent weeks, as local newspapers have reported significant problems at Oxford and North Bristol; the latest trusts to deploy the system as part of the National Programme for IT in the NHS.

The trusts say the introduction of such a big electronic patient record systemis a massive operational change – and that while any short-term disruption for patients is regrettable, the long-term benefits will mean patients get better care.

So what are these long-term benefits, and why have we not heard more about them? While Millennium is undoubtedly still “bedding in” at Oxford, North Bristol and Bath (the other, quieter, ‘greenfield’ site) other Southern trusts have been using the system for many years.

Potential benefits

EHealth Insider has discovered that the seven trusts that have been using the system since Fujitsu was local service provider for the South are monitoring the benefits (Fujitsu got eight sites live, but one, Worthing and Southlands Hospitals NHS Trust switched it off in November 2009).

These seven trusts are submitting quarterly reports to the benefits realisation sub-group of the Southern CRS Live Sites Executive – a voluntary group made up of members from each of the Southern trusts live with Cerner Millennium. However, the results have not been made public.

The lack of publicly available evidence of what has been achieved for £2.7 billion of spending on care record systems across England attracted the attention of the Commons’ public accounts committee.

In the report of its hearings on last year’s critical National Audit Office report on CRS, the PAC noted that the Department of Health had failed to provide a statement of NPfIT benefits promised in March 2010 until May 2011; and that it had failed completely to provide a second annual update, due in September 2011.

The DH told EHI it would provide an updated statement of benefits to the committee and was working with the NAO on a suitable timeframe.

The Southern sites have been submitting reports to feed into this statement since late last year. While these reports have not been released to EHI, the most common potential benefits are outlined in a Benefits Position report from June 2011.

These include: improved recording and accuracy of demographic details; reducing delays in patient care; a reduction in duplicate requests for tests; increased theatre utilisation; a reduction in clinical incidents and improved recovery of costs in emergency departments.

However, board reports that mention benefits realisation, that EHI has been able to find by trawling trust websites, suggest that many of these benefits are not being precisely quantified, or given monetary values.

As such, it’s hard to say whether a good business case was ever made for such a large investment; or whether one could be made now. It is also clear that while potential benefits can be identified, some trusts are having problems realising them in practice.

One reason for this could be that many are still in the process of rolling out the clinical functionality available to them since the Fujitsu quit the national programme, BT took over the support and maintenance of the live sites, moved them into its own data centre, and gave them access to the ‘London’ version of Millennium, known as LC1e.

Much of this functionality has been available to the ‘greenfield’ sites from the outset. Despite issues in its outpatients department, North Bristol has deployed Cerner Millennium in its A&E department, two minor injury units, 65 wards, maternity and all theatres.

Oxford is using Millennium as a patient administration system, and in its maternity and A&E departments, while Bath has gone live across all theatres.

Progress at Buckinghamshire and Surrey

Two trusts agreed to be interviewed about the benefits realised from using Cerner Millennium, while a third provided a written statement. EHI has officially requested benefits reports from those trusts that refused to provide information.

Buckinghamshire Healthcare NHS Trust installed Millennium in September 2006. In November 2007, problems with monitoring infection control were highlighted to the trust’s board.

A year on, the trust’s IM&T Strategy said there were “significant issues” restricting the trust’s ability to report and deliver analysed information for both performance management and clinical governance that were due, in large part, to the introduction of the CRS.

However, Buckinghamshire’sCRS programme manager, Katie Coward, told EHI that benefits are now being realised. These include cost savings from the removal of legacy systems and increased security through the use of smartcards.

“We have realised some benefits, particularly over the whole programme. We had two legacy PAS systems, now we have one PAS integrated within the national spine and PDS connected,” she says.

Lessons learned from the first deployment meant a second hospital deployment 18 months later went “like clockwork.” Buckinghamshire Healthcare got its LC1e upgrade in September last year, and this also went “pretty smoothly.”

“It’s a challenging deployment – a big project even as an upgrade – so we expect there to be some challenges, but it went pretty much to plan.”

Coward says her trust now has a solid platform on which to build an electronic patient record system. A&E is currently going live and the trust is rolling out the system across its theatres.

Cerner Millennium was installed at Surrey and Sussex Healthcare NHS Trust in April 2007. Director of information and facilities Ian Mackenzie says the system has reduced the time taken to book follow-up appointments in outpatients.

It is also supporting clinical decision-making, through the deployment of order communications in radiology and – soon – pathology.

The system is live in all theatres, but reporting problems mean Mackenzie cannot yet tell if Millennium has increased theatre utilisation. The introduction of smartcards and connection to the PDS has definitely meant savings in staff time, however.

Weston Area Health NHS Trust went live with Millennium in July 2006. In a statement, it said it is operating on a stable platform and continuing to develop additional functionality locally.

“The February 2011 deployment was significant and there were some changes to the programme-wide timetable and the go-live date, as may have been expected with such a large and complex exercise,” its statement says.

“The trust has been satisfied with the outcome, following the resolution of some initial operational issues. We have realised some key benefits and continue to review our realisation programme to extract maximum impact.”

The rest is silence

EHI has also been able to get some information about the impact of Cerner Millennium at Winchester and Eastleigh Healthcare NHS Trust. It went live in February 2007 and received the LC1e upgrade in December 2010.

A report to the board in April last year says the expected benefits of the upgrade included a reduction in duplicate tests and paper requests, full lab result viewing in the message centre releasing ‘time to care’, a reduction in handover time and electronic tracking of case notes.

While some of these benefits had been realised by April, such as electronic tracking of case notes, most were yet to come to fruition.

A further report in June revealed some unexpected benefits, such as outpatient activity reporting and being able to change appointments to telephone slots when patients were not able to attend.

However, it also noted that where the A&E system FirstNet and order communications had not been deployed there was a marked reduction in the realisation of benefits, and particularly clinical benefits.

A report to the board also said it was struggling to realise benefits in other areas because of “core functionality currently underperforming.”

Milton Keynes Hospital NHS Foundation Trust, which went live in February 2007, and Taunton and Somerset NHS Trust, which went live after many delays in December 2007, both had well-reported problems with their initial deployments, but declined to provide any information about their experiences with Cerner Millennium since.

The first trust to go live with Cerner Millennium R0 in December 2005, the Nuffield Orthopaedic Hospital, recently merged with Oxford University Hospitals NHS Trust – the latest to go live with the updated system.