Three primary care trusts in London have declined to take the ‘interim’ RiO community system being offered by BT due to concerns about its limited clinical functionality and the high costs of implementation they would face.

Individual community and mental health trusts face implementation costs of up to £500,000 and the prospect of having to move from the ‘interim solution’ – likely to last between 18 months to three years – to an eventual ‘strategic solution’. When they move they face the double whammy of having to pay similar implementation costs all over again.

A spokesperson for BT-led Capital Care Alliance (CCA), the local service provider for London, confirmed to EHI Primary Care that three PCTs had declined at an early stage to take the system. Two London PCTs, Barnet and Hammersmith and Fulham, have so far gone live with the initial stages of the RiO system from CSE Servelec.

One of the PCTs to refuse the interim system is Sutton and Merton. In its business case for 2006/2007 it says: "The PCT will not be proceeding with RiO, the London-wide LSP interim solution for community and mental health services. This is due to the implementation costs estimated at £500,000, and the limited life of the system, before the final solution becomes available, which is currently estimated for 2009. Potentially, this will then require a similar amount of money to roll out."

Sutton and Merton instead plans to buy a product available from its existing supplier In4Tek.

Another PCT to decline to take the system is Kensington and Chelsea which has decided to stick with its existing community system from CIS until Carecast community functionality hopefully becomes available in 2008-2009.

BT is contracted to deliver a system to support community health as part of the National Programme for IT (NPfIT). This was to have been delivered as part of a late-running integrated clinical system called Carecast, being developed by IDX, which was acquired by General Electric in March this year.

Carecast was meant to be ready and available from 2005, but is behind schedule. So far just one acute hospital in London has received the Carecast system from BT and no community sites have the system.

To bridge the gap in community systems NHS Connecting for Health, the agency running the NHS IT programme, instructed BT to provide an ‘interim’ system to primary and mental health trusts in the capital. BT signed a deal with clinical software provider CSE Servelec to install its off the shelf RiO community health system – a system already in use at 14 trusts across the UK.

In London the RiO system is being set up with a standard configuration for mental health and community services to create common business processes. BT is centrally hosting the software from its data centre.

The version of RiO will also be essentially a stand alone administrative system, not initially connected to the NHS data spine and so unable to share data with other NPfIT systems. It will also lack any connections to local GP or social services information systems.

For some PCTs the system offered is much welcomed and a big improvement on what they have already. Southwark PCT plans to go live by July 2006 and in a December project paper it wrote: "It has now become apparent that a more robust and clinically rich solution is required for the service and RiO meets this requirement."

However some other PCTs have questions over whether the system initially offered will provide the clinical tools they need. A March board paper for Westminster PCT states: "It was confirmed that in the March code drop RiO offers mainly administrative support and that there is limited initial clinical functionality."

The same paper makes clear that RiO does not support clinical coding and does not meet clinical requirements. "Because of reliance on a free text field it is difficult to use RiO for previous medical history, drugs history and current medication information in a manner that supports clinical requirements."

According to the trust board paper other clinical problems include "issues of clinical fit with both RiO and eSAP".

Similar concerns are identified as risks by Hillingdon PCT, which in a separate board paper said: "There is a risk that the delivered version of RiO might not adequately fill the clinical needs of some staff e.g. the wheelchair service." Hillingdon PCT also expresses concerns that there may be slippage in the London deployment timetable.

Hillingdon estimates the three year project cost of implementing RiO at between £356,500 and £742,250 depending on the extent to which data is cleansed and migrated by a specialist firm.

Another disincentive for PCTs taking the standardised system is that they must have to change their local practices and procedures to match those of RiO. Board papers from Lambeth PCT state "the PCT has looked at how existing processes and practices need to be adapted for RiO".

Yet another stumbling block arises from NHS reforms and the uncertainty over the future of community services. With many PCTs now likely to lose responsibility for the direct provision of the community services they have only a limited incentive to invest in community IT systems.

BT says it will ensure that RiO is eventually integrated into the integrated ‘strategic’ Carecast clinical solution when this becomes available. The BT spokesperson said this was "due next year, but the details have not yet been agreed".

He added: "All the integration to this strategic solution will be done by us but local implementation costs will have to be met locally."

The spokesperson confirmed to EHI Primary Care that "local trusts meet the implementation costs". The spokesperson said that the CfH fixed deployment cost – the basic that BT as LSP can charge for a standard implementation – is approximately £200,000 – £300,000.

He told EHI Primary Care: "20 PCTs and mental health trusts have so far committed to take RiO", but the spokesperson added that the situation "was highly flexible with some trusts saying can I go back to next year or come up the queue." BT was unable to identify which PCTs these would be.

The spokesperson said that BT projected that in addition to the two PCTs currently using RiO a further 12 should go live by the end of December this year.