Milton Keynes’ CRS caused ‘near melt down’

The deployment of a national programme care records system at Milton Keynes Hospital NHS Foundation Trust “developed into an untenable situation which resulted in near melt down of the organisation.”

According to papers from the CRS project board, obtained by E-Health Insider under the Freedom of Information Act, the trust experienced a far from smooth go-live of the Cerner Millennium system. The CRS project team described it as “eight weeks of extreme pressure and operational issues to the acute trust.”

Board papers from the CRS project board, dating from July 2005 to June 2007, show a turbulent journey before the system finally went live on 24 February 2007.

Milton Keynes was an early implementer site for the local service provider, Fujitsu, and the acute trust urgently required a new patient administration system to replace its existing legacy system, which was considered obsolete.

An initial go-live was scheduled for 16 June 2006. The system was meant to include basic PAS, clinical noting and order communications, maternity, A&E, theatres and information for analysis functionality.

However, despite a project initiation document being agreed in November 2005, the project board was unable to familiarise itself with the actual system until March 2006, when Fujitsu first delivered a system build for testing. This was just two months before the expected go-live date.

“Lack of access to a working version of Millennium is impacting on the process gap analysis,” the CRS project board noted. “The change team has to make a huge number of issues as to how CRS will work. Knowledge has been based on seeing a few demonstrations, playing the demonstration CD and requesting clarification from Cerner via Fujitsu.”

Maternity was dropped from the system requirements, after Cerner was only able to provide a webcast demonstration of the module from Kansas City. The board papers say staff were “not confident with what they witnessed.”

When EHI reported on Milton Keynes’s implementation, which also covered the community hospitals run by Milton Keynes Primary Care Trust, Fujitsu said it had benefited from the experience gained from earlier implementations.

However, the minutes from the CRS project board show problems being continuously identified and go-live dates continuing to slip. In two years of planning, the go-live date changed seven times. The cost of the slippages was almost £800,000.

Gateway reports before each planned go-live identified risks as “red light”, preventing implementation from going ahead. Issues identified included an unstable build, major concerns about the reporting functionality and a lack of security plans for the new system.

Timescales for data migration were also considered tight, with delays from other sites in the Fujitsu Domain 1 area – Nuffield Orthopaedic Centre NHS Trust; Buckinghamshire Hospitals NHS Trust and Buckinghamshire Primary Care Trust – impacting on its implementation.

The green-light to go ahead with the deployment was only given three weeks ahead of the actual go-live. However, post-go-live, doctors began to identify a series of problems, resulting in the “near melt down” described by the project board.

The board papers suggest that problems at this stage included bed availability not displaying correctly, notes for clinics going missing, patient appointments not displaying on lists, reports not printing correctly, GP labels being unavailable, clinic rebuilds being necessary, back office help being unavailable, printers not working and passwords being forgotten.

Training was also an issue, with staff needing help but trainers unable to cope with demand. The project board reported: “Despite following the correct escalation processes, there was a very slow response from service management, which has resulted in eight weeks of extreme pressure and operational issues to the acute trust. 

“Staff are reporting general ‘clunkiness’ of the system, slowness when trying to do things and that it is not intuitive. This has been reported to the health authority and Fujitsu and there is an agreement that we should urgently review the processes in order to try and make the system meet operational needs better.”

The first fortnight after go-live saw 1,166 calls to the helpdesk. A letter published by disgruntled clinicians prompted a visit by NHS chief executive David Nicholson and the then-director general of NHS IT, Richard Granger.

Following the visit, NHS Connecting for Health sent a representative to work with the trust in resolving issues. The 11 key issues identified by the trust were resolved in June 2007, and the trust’s CRS project board disbanded.

The board reported: “An agreed list of issues was identified and a Fujitsu team worked with the trust and Connecting for Health to resolve these issues. Whilst the majority of these issues are resolved there are some remaining reports still to be installed into cert for testing.

“Performance is greatly improved but there are still incidences of reduction in speed and log on ability. These reports are taken seriously but we have a reliance on staff to continue reporting to the help desk.”