The delivery of the strategic Care Record Service solution in the North West and West Midlands cluster has been confirmed as running badly late and subject to "significant delays" until at least late 2007.
As a result, strategic health authorities in the area are now developing "delay mitigation plans" based on interim use of existing systems from software supplier iSoft.
SHA board papers from within the region state that the strategic Lorenzo CRS solution, which is meant to be delivered by iSoft to the NWWM local service provider CSC Alliance, will now not be available until the end of 2007. Further papers seen from the North Eastern cluster, however, state the strategic CRS solution may not be available until late 2008.
In a 25 January 2006 paper presented to the board of West Midlands SHA, chief information officer Colin Bexley states: "The development of the strategic clinical NCRS product for the North west Midlands Cluster, iSoft’s Lorenzo product, is running significantly behind plan. It is likely that the first Lorenzo clinical modules will not be available until late 2007."
Although over 40 NHS sites in NWWM have been provided with existing iSoft iPM patient administration systems (PAS), the overwhelming majority have been community and mental health trusts. These had an urgent requirement for access discharge and transfer functionality, or needed a PAS to implement Choose and Book.
Mike Davies, senior research analyst with Butler Group, told EHI: "iPM is the old PIMS product, pure and simple, though it has been toughened and strengthened by iSoft and partners." He said that he had been told by a director of information at one NHS trust that the functionality of PIMS is only now to the standard that was to have been provided in 2000.
To date just one acute trust in NWWM has actually implemented the IPM system under the CfH programme. "There is still only one acute PAS deployment in the NWWM cluster (Birmingham Children’s Hospital)," states the West Midlands SHA board paper. EHI understands that the trust has deploted iPM together with an A+E system.
As previously reported by E-Health Insider, in the absence of the strategic Lorenzo solution, CfH and the two LSPs using iSoft have been working on series of alternatives, based on offering existing iSoft products to NHS Trusts in various configurations.
A variety of codenames, including ‘Plymouth’ or ‘Derriford’, have been used. These are either based on deploying either the iSoft iPM patient administration system as a standalone PAS or providing iPM together with iSoft’s iCM clinical system. Another variation on the theme is to run iCM alongside existing non-iSoft PAS systems, such as McKesson.
Davis questioned the whether such systems would actually be replaced by eventual strategic solutions. "I think we might see the interim solutions still being there in the longer term," he said, adding: "If we don’t start to see some catching up in delivery and development of software the programme will never be finished."
The 25 January paper states: "The proposed mitigation plan is to deploy iSoft’s existing iCM product to a significant number of trusts during 2006/7. This will provide order communications, clinical documentation and some decision support functionality to acute trusts."
It is not clear yet, however, whether iCM will also be able to meet the specific requirements of mental health trusts and the paper notes. "Further work is underway to determine whether iCM functionality can deliver benefits to community and mental health services."
The West Midlands SHA paper says the latest delays will have an impact on delivering benefits to users. "It is clear that delays to the availability of functionality will reduce the level of benefits available over the next two years." It adds that local health communities "will also need to consider how to deliver service change despite delayed IT solutions when developing their Integrated Service Improvement Plans".
Another factor acknowledged as having a big impact on local and national CfH plans are the new requirements in NHS policy around choice and plurality of service provision, with the need to share data and care pathway management across the NHS, private sector and social care. "Current NPfIT plans for the next 2 to 3 years do not yet support this requirement effectively; further work is required to determine whether and how this requirement can be supported."
The paper says that the aim is to complete the delay mitigation plans as part of the LSP re-planning exercise, "which is expected to complete by March 2006".
While West Midlands SHA talks of another two year of delays until the core CRS solution becomes available, at least one other SHA believes the delays will prove even longer. A December 2005 board paper from West Yorkshire SHA, part of the North East cluster for which Accenture is LSP, puts the date for the delivery of the strategic Lorenzo CRS solution at late 2008. It states that a suitable solution for use at Leeds Teaching Hospitals NHS Trust – the largest in Europe – is now running two years late.
"In the original 2004 plan the Trust were due to implement Phase 2 Release 2 [of the Lorenzo CRS solution] in December 2006. It is now unlikely that a suitable product will be available before the end of 2008."
The West Yorkshire SHA board paper goes on to warn that the extent of the delays mean that implementation funds may have run out or no longer be available when a suitable product eventually becomes available: "If further funding is not forthcoming then it is possible that the trust will not be in a position to implement CfH services. This will be a problem for all trusts in a similar position to Leeds."