A London PCT has had to switch off its computer system and start recording patients’ details with pen and paper while it waits for a replacement to be delivered by the NHS IT programme.

Enfield Primary Care Trust has switched off its two ageing iSoft PiMS patient administration systems, after experiencing frequent problems and interruptions to the service — including outages of over seven days. Following a failure in March, the system looks unlikely to be fully restored until it is replaced in the autumn.

According to internal board papers at the trust, the outages left the trust unable to electronically record births and deaths, to record or schedule vaccinations and immunisations, or schedule pre-school or school health checks. The PCT says it has also been left unable to record patient activity, creating a potential clinical and business risk to the trust.

In a board paper in May, the PCT said PiMS "is frequently unavailable for up to 15% of each working week and this has been ongoing throughout 2005/2006". The PCT said it has also experienced a number of "major outages" of PiMS lasting more than seven days, the most recent being in March.

The trust is now planning to take RiO from CSE Servelec, the interim community system being offered in London under the NHS IT programme. Planning for installing the new system has just begun and it is hoped it can be implemented by the end of the year.

"We had a failure on 13 March and since then there’s only been very limited access," Jo Ohlson, acting chief executive at the PCT told E-Health Insider. She explained that the main clinical areas the PCT had used PiMS for were child immunisation, health visitor statutory visits and notification of new births.

"We have reverted to paper," confirmed Ohlson. She added that fortunately the impact on patients’ clinical care not been great as PiMS was "pretty limited as a clinical system" though there "has been an issue about scheduling of appointments".

Ohlson told EHI that they had been running two versions of PiMS — 1.7.4 and 1.9.3 — both of which were unstable "partly due to our infrastructure". She explained that the trust had been aware of the need to upgrade its versions of PiMS and been planning to take the interim community solution since last summer.

She added: "It would have been better if PiMS could have been maintained, but we have managed to save the data. But until RiO goes live we will be using paper and Access databases."

Ohlson said she had been told by IT colleagues that it had been impossible to "match the original PiMS server environment" on modern hardware. "I’m told it’s like trying to put a modern engine into a classic car."

She said: "We have not done an upgrade of PiMS as we are going to go for RiO. The business case has been approved and we had the kick off meeting today."

The acting chief executive explained that the PCT did not have to pay for RiO, other than implementation costs which are budgeted as £170,000 in the first year. She said the plan was to go live with the new system by the end of the year.

Until RiO is installed she said Enfield will "continue working with its business continuity plans".

When contacted by EHI last week iSoft said it had not initially been notified of the failure in March, and when it was eventually notified had advised the PCT that the way to resolve the problem was to upgrade to PiMS.

"The March 2006 outage was caused by Enfield doing the Citrix upgrade themselves presumably as a cost-cutting measure and to upgrade its ageing infrastructure," said an iSoft spokesperson.

They told EHI that the company had unfortunately had to withdraw its technical support to the PCT last week after the NHS organsiation failed to pay its outstanding support bills.

"Enfield only logged a couple of calls a month, usually for technical support and fixed within the SLA," the spokesperson told EHI. "It gradually cut down the service from iSOFT from a fully managed service to software support and then refused to pay invoices."

Asked whether iSoft had withdrawn technical support Ohlson told EHI "That isn’t my understanding. The PiMS system remains supported by iSoft".