Barnet and Chase Farm: two months on

In the past four weeks EHI has been told of a range of problems being experienced by users and patients following the go-live at Barnet and Chase Farm.

But are these the inevitable teething problems associated with change and installing a big complex new system? The trust is adamant that they are. EHI spoke to the trust and local service provider (LSP) BT.

Eight weeks into the new Cerner Millennium installation at Barnet and Chase Farm – the trust announced it had gone live four weeks after first switching on – and there are teething problems in how the new system is working in some parts of the trust.

A number of E-Health insider readers told us that the system was causing chaos in parts of the trust. Clinicians, they said, were turning up at the wrong clinics at the wrong time to be faced with the wrong patients.

In A&E it was claimed that waiting times were actually getting longer as staff struggled to find records and triage patients. As a result both staff and patients were said to be getting frustrated.

Despite staff training, many clerical and administrative staff were said to still not understand the system, which was still using American terminology causing confusion and delays in arranging patient appointments, EHI was told.

Was this – as some maintained – a repeat of the same types of problem that had previously hit Milton Keynes and the Nuffield Orthopaedic Centre when they installed Cerner Millennium R0?

Or – as the trust insisted in an internal memo – just the normal teething problems associated with any major IT change?

Other implementations in the South, such as at Winchester and Surrey and Sussex, appear to have gone much more smoothly with very few reported problems.

All eyes have been on Barnet and Chase Farm as it is the first NHS trust in London to install Cerner Millenium R0. How it is getting on with the new system is a question that matters to the whole of the health service in London.

Alex Nunes, chair of the public and patient involvement forum, is firmly in the teething problems camp. “They have all the usual problems associated with putting in a new computer system,” he told EHI.

“The biggest problem has been transferring lists from the old system onto the new one,” he added. Patients had reported being called for the wrong procedure or not been able to make an appointment at all.

“Patients have suffered and that’s terrible.”

Having met formally with trust directors, he felt reassured that these teething problems were being solved although he will keep tabs on it.

One of these was to anticipate as much as possible and to prepare for the unexpected."
Remon Ghazal, director of IM&T, Barnet and Chase Farm

Remon Ghazal, director of IM&T at the trust, was equally firm that the problems reported to EHI were teething problems. He took some time out of a very busy schedule to talk through the main issues.

“We looked to the London Programme as our contact with the outside world and to help us learn any lessons we can,” he said. “One of these was to anticipate as much as possible and to prepare for the unexpected.”

In the run up to switch over, the trust trained 1200 of its 4000+ staff to use the new system. They reviewed all the clinics at the trust’s seven sites and engaged with clinical staff to keep them informed.

Each area (and this was loosely defined) had a champion to act as a link between the coalface and the IT department.

They engaged more than 100 support staff as floorwalkers. Some were the trust’s own IT people but others came from Cerner, BT and subcontractors Perot Systems.

They planned to start with 24/7 floorwalkers, moving to business hours, then special areas and finally remote floorwalking. “That means telephone support,’ said Mr Ghazal.

The idea was that areas would step down through these stages as they felt comfortable.

The legacy PAS system came offline on Thursday, 19 July at 6.00pm. A+E came up on the new system on 21 July at 2.30pm on. The wards came up on 22 July during the evening and outpatients on the morning of 24 July.

Almost immediately some problems became apparent.

“People were not feeling comfortable because it was different,” said Mr Ghazal. “Change is the biggest factor.”

They had trained 1200 people in the six weeks before the switch. “But people who trained in the first week had forgotten so some rapid response training was required.”

A+E was, he says, pretty smooth in its uptake of the new PAS. They stepped down to remote support within two weeks.

“We have maintained our A&E performance,” he said. “The staff have embraced the new system.”

Bigger problems emerged in the central appointments area that deals with all booked appointments.

“There was a huge surge of calls to that area,” he admitted. In addition to the patients with the wrong appointments or no appointments at all were some rather more simple problems.

“Many of the calls were from patients on long term condition management programmes who were getting letters in a different type face or with a different letterhead,” explained Mr Ghazal. “These are people for whom stability is very important.”

The next hurdle will be to see how the system performs on management tasks such as reporting. “We are working through that now,” said Mr Ghazal. “We are not out of the woods yet.”

On a corporate level, neither BT (whose representative sat in on the interview) nor Barnet and Chase Farm Trust are denying that there were problems.

“By no means are we saying that there was no disruption,” said Mr Ghazal. “But the hospital continued to see patients, A+E performance and infection rates were maintained. We have a big list of things we need to work through but the product works and the process was good.”

His advice to anyone changing their PAS is to be pragmatic and to sell the benefits.

“Changing a PAS is not something we do everyday,” he said. “It will come with a host of problems but also some huge benefits.

“We did not anticipate the level of benefits that we are already seeing. We can now manage beds real time and we can see how our A+E is performing and whether they need more help before they call for it. It is extremely powerful.”

Links

Barnet and Chase Farm switch on Cerner