EHI interview: Andrew Spence

E-Health Insider reporter Sarah Bruce talks to Andrew Spence, director of healthcare strategy for NHS local service provider CSC, about the importance of Lorenzo, progress in rolling it out, and the future prospects for healthcare IT in England.

In April this year, director general of informatics Christine Connelly gave England’s two remaining local service providers two options.

Demonstrate significant progress with the ‘strategic’ electronic patient record systems that they are due to deliver under the National Programme for IT in the NHS, or see the programme’s approach reconsidered.

Connelly made it clear that she “would not rule out” terminating the contracts of CSC and BT if they failed to get iSoft’s Lorenzo into a care setting by November and an acute trust by March, and Cerner’s Millennium into another London trust by November.

With two months to go to the November deadline, Andrew Spence, CSC’s director of healthcare strategy, is in no doubt about the importance of delivery. “ISoft’s future, as much as CSC’s in healthcare, is dependent on the development of Lorenzo,” he says.

One deadline, many trusts

Speaking at CSC’s London Offices at St Mary Axe – better known as “the gherkin” – Spence is confident that progress is being made. “We are confident that both the November and March deadlines will be met, we are also working on the subsequent roll-out so we don’t have all our efforts focused on these deadlines,” he says.

E-Health Insider recently revealed that NHS Bury is working towards the November deadline to implement Lorenzo Regional Care Release 1.9 in a primary care setting.

Although there has been no official confirmation, it looks as if University Hospitals of Morecambe Bay NHS Trust is the organisation working towards getting Lorenzo “working smoothly” in an acute setting by March. It has been rolling out versions of Lorenzo since November 2008.

But Spence suggests there could be other options. “What we’ve been doing with the NHS is working with a handful of trusts to work out which are most ready to go-live; which would benefit the most; which have got the best quality of data,” he says.

“There are four or five trusts we’ve been working with. To select which one will go-live first is not a CSC decision – it’s a CSC, SHA [Strategic Health Authority], CfH [NHS Connecting for Health] and trust decision. We’re very fortunate that we’ve got an number of trusts that are almost competing to be the first go-live.”

He also indicates that CSC is looking to next summer and beyond. “Next year, you’ll see a gradual ramp up in the number of trusts taking Lorenzo.

“You’ll see a short period after the first go-live of the first trust in March, just to make sure everything has settled down. And then you will see a steady progression of other trusts taking Lorenzo,” he says. “We’ve got plans for the next two dozen trusts to take Lorenzo.”

No big bangs

Despite this, Spence stresses that Lorenzo will not be implemented ‘big-bang’ style. He says: “It’s important that we roll-out on an incremental basis for the first handful of trusts.

“Then, as everyone gains confidence in the product, we’ll do broader scale roll-outs. But we’re never planning on doing these go-live big bangs where everyone goes live at midnight on 1 January – simply because it’s too risky.”

Of course, if a general election is called and there is a change of government, the deadlines set by Connelly may no longer be relevant. The recently published Independent Review of NHS IT and the subsequent response from the Conservative Party called for the national programme to be dismantled and for the LSP contracts to be “halted and renegotiated.”

“We recognise that whichever party wins the next election there will be an element of refocusing the national programme and its priorities,” Spence says. “CSC stands ready to work with an incoming government to work out how we can fulfill our contractual obligations in the most effective way possible.”

However, when he is asked whether records could be held at a local level, as already happens in some Continental European countries, and as many want to happen in the UK, Spence argues that this could add new costs.

“Each individual hospital would have its own hardware systems,” he says. “You’ll still have to have the same network in place to share the facilities, so it could be done. Some trusts are going down that route – those that are opting out.”

New views of data

CSC is also focusing on interoperability and how to make sure that trusts using Lorenzo or planning to use Lorenzo can make best use of their existing systems.

He says: “We’re looking at things like self-service kiosks and making them available in acute hospitals. We would see our role being about how we facilitate the integration of the kiosks, particularly with all the systems that we are responsible for in secondary care.”

Spence says that CSC is also developing a prototype clinical workspace with CfH to provide clinicians with a complete view of patient information.

He says: “We’re working with CfH and some other partners to see whether we can join up those fragments of data about a single patient that are taken from a number of different systems and present it on screen to the clinician.”

Spence argues that this will not be an alternative to or competitor for Lorenzo, as it is not a transactional tool. It will just provide a more coherent view of the data. “We don’t see it as competing with Lorenzo, we see it as complementary, and in many ways it will be getting trusts ready to take Lorenzo, which will join up a lot more data.”

Ruthlessly focused

Although these developments are going on, Spence says that Lorenzo will continue to be CSC’s main priority. Once it is rolled-out further, the company will look at more ways to interoperate and innovate within the NHS.

“At the moment we are ruthlessly focused on getting Lorenzo out and getting the confidence in the product,” he says. “Then we can move forward with other projects that we are working on.”