Insider view: Jon Hoeksma

Cerner’s decision to accuse two Cambridge trusts of rigging their eHospital electronic patient records procurement in favour of Epic is a serious charge.

It will be seen by many as being motivated by a serious case of sour grapes from a supplier smarting after losing out to its arch rival.

The trust flatly denies the accusations and it is to be hoped that the lawyers don’t get involved (although a letter seen by eHealth Insider suggests that they are already on board). So this is a high risk move for Cerner. Why do it?

Pissed off

In part there is no question that the senior management of the firm is seriously pissed off that they competed in good faith in a high cost, high profile procurement that, in their view, now looks as if it was only ever going to go one way.

Industry rumours suggested that Epic was highly favoured by the Cambridge University Hospitals NHS Foundation Trust, which led the procurement process. But that is not nearly the same thing as running a procurement to get one outcome.

Some other suppliers who bid have privately grumbled. But none are writing semi-public letters to the chief executive reminding them of their responsibilities to the “hard working tax-payer” to spend money “wisely, fairly and in a transparent manner.”

Indeed, it is difficult to see what success would look like for Cerner in a dispute with Cambridge.

Even if the trust were to re-run the eHospital procurement as the company is demanding – and there is no suggestion that it will – just how likely would it be to select a supplier that has publically called it out?

This suggests there must be more to Cerner’s move than irritation. Fear and competitive advantage must surely be factors.

And possibly worried

Cerner is riding at an all-time high in the US and has a great installed base in the NHS, but despite the collapse of the National Programme for IT in the NHS, in the key PAS and EPR market it is serially failing to win new procurements.

The last open tender that it won was Royal Berkshire way back in June 2009, when the trust chose to go with University of Pittsburgh Medical Centre as implementer, in a move no other trust has followed.

Instead, the majority of new tenders being put out by biggish and medium–sized trusts looking for PAS and EPR replacements and extensions are being won by McKesson acquisition System C, with a smaller number going to others.

As a result, Cerner has targeted its efforts at the big NHS academic medical centres and teaching hospitals. Put simply, Cambridge’s eHospital project is exactly the kind of marquee project that Cerner needs to win.

Meanwhile, back in its home US market, the more recent orthodoxy is becoming that when Cerner goes head to head with Epic it’s the folks from Wisconsin with a fondness for MUMPS-based software and tree-houses that win.

That’s not a trend that Kansas-based Cerner wants to cross the Atlantic. So, having even the smallest chance of derailing Epic’s entry into the NHS market at a gilt-edged UK-reference site must be a consideration behind the company’s move.

Another consideration may be to plant the seed of an idea in the mind of NHS IT directors going through procurements that they might get challenged by a big supplier on how and why they make decisions. 

Some of the stories that EHI has run recently on tender outcomes have raised eyebrows among commenters wondering how those decisions were made. It may just be that Cerner has the size and firepower to challenge a decision in a particularly high profile case.

Risky

There is no getting away from the fact that the challenge is risky. It is likely to generate resentment beyond the senior management at Cambridge. Critically, big IT-enabled projects depend on trust and partnership.

Should Cerner become perceived as ‘difficult’ it is unlikely to do the company any favours.

However, there is also a chance that Cerner may be doing other trusts a favour.

The NHS is being urged to invest in IT to meet eye watering financial targets. Trusts need to know what works and what doesn’t.  And the evidence base of benefits of different systems, their relative merits and usability remains poor.

The public sector procurement processes trusts have to follow also remain extremely unwieldy and expensive.  And these are costs that suppliers pass on to their NHS customers. Mechanisms designed to protect the public purse need to be reviewed again.

There are clearly times when trusts just get suppliers to jump through the hoops to make up the numbers – this is a huge waste of time, money and effort on all sides.

There are times when it is perfectly legitimate for trusts to pick a particular supplier, if others can’t meet its requirements. And, at the same time, a commitment to innovation must clearly mean trying new approaches, systems and suppliers.

But it might just work for the NHS

So perhaps the most welcome change that could come from the Cambridge eHospital dispute would be far greater insight into the decision-making, evaluation, and selection processes and criteria used by trusts in major IT procurements.

Cambridge has been challenged to publish such details; it should accept the challenge. Not only would this serve to answer the charges made by Cerner, but it would provide a valuable reference source for other trusts beginning procurements.

In fact, procurement details and evaluations should be routinely published. Arguments about commercial confidentiality are surely outweighed by the benefits such transparency would bring.

Full and routine publication would also be in step with the government’s commitment to transparency and openness in the public sector.

Crucially, such disclosure should include pricing details. The NHS as a whole and individual NHS organisations would surely be far better served by sharing full details of the pricing of clinical IT systems.

While it surely has narrower motives, if Cerner’s challenge to the Cambridge eHospital tender helps to promote greater transparency on procurement processes, pricing, and the evaluation of systems installed, then it may wind up benefitting the wider NHS IT market and health service as a whole.