Over the past 24 years Texan-born O’Connell says he has worked on either buying or building complex space, earth orbiting systems or command and control systems for international agencies; most of these projects he says “are classified”.
“I’ve always been associated with extraordinarily large systems, typically advanced space systems for the intelligence agencies and some of the most advanced missile systems for the forces.” During the course of his career O’Connell says that he become “a turn-around specialist for very large programmes”.
He says that BT Health was his first major assignment in health arena, and that he came to the project as he was looking for a fresh challenge outside the aerospace industry, and wanted “IT at the bottom of it, but still looking for a challenge involving a very large programme, multi-year, multi-billion expenditure. That’s the kind of expertise I bring to the table, managing those types of things.” Although the variables are now things like blood pressure rather than air speed he says the fundamental programme management challenges remain the same.
He acknowledges that he was hired by BT to help turn around their performance on their three NPfIT contracts. Uniquely BT has the LSP contract for London, the deal to deliver the N3 network and finally is responsible for delivering the national spine and summary care record.
Asked how the three NPfIT programmes now stand O’Connell says: “The direction of travel is quite positive.”
BT as LSP in London
Turning to BT’s role as LSP in London O’Connell says the initial challenge he faced “was to solidify our performance on the London programme.”
“Today in London, in the non-acute space, the London programme is performing”, citing 155 deployments in community, mental health and general practice. “It’s probably unknown to too many people that we have that many deployments because they’ve gone well.”
In addition the PACS roll-out programme in London was completed in March with delivery to 21 trusts, currently stand alone but with plans to link them into a data centre from later this year.
The big miss so far is in acute sector, where BT has the worst delivery record of the three remaining LSPs – just one trust in four years, and that a system that is now redundant due to a supplier switch. Queen Mary Sidcup remains the only site to get a PAS system from BT, out of the total of 32 it must deliver.
The 32 target includes the five iSoft trusts in London, which he confirms BT intends to deliver to even though they currently have a different status, with contracts held by fellow LSP CSC. However he adds “If it turns out that the iSoft trusts in London are not to be at the end, well then they are not to be.”
Questioned on when the acute programme will be completed O’Connell says: “It’s a few years.” Variables BT is managing include trusts’ readiness to take systems which he describes as a large effort. “It’s not just a question of the supply side it’s the demand side as well. So it will be a few years before we are able to roll it out fully.”
Asked whether BT will provide any special help to Queen Mary’s Sidcup NHS Trust which faces the invidious position of replacing the IDX PAS system BT put in just over a year ago, before switching to Cerner, O’Connell says: “Yes, we will make sure it is a success for them and us.”
He says the pressure is on to deliver “from ourselves and the external world to ensure this whole thing works”. O’Connell later adds: “We need to get some acutes under our belt”.
An essential part of this delivery will be to ensure that it is of sufficient quality and that implementations when they come do not cause huge problems or disruption at trusts. “We are more or less there and will ensure we will do that, says the BT Health boss. “I think lessons have been learned from a variety of places including elsewhere in the country.”
O’Connell sets out BT’s position: “As everyone knows there were some issues at the beginning of the programme and we have since switched supplier from GE [the company that bought IDX] to Cerner and we are about to begin the deployment of acutes this summer.”
He adds “We think by Christmas we should have three acutes in, and in the next year – depending on the appetite of the authority – we should have a proper number for next year and the years thereafter.” The first three will be Barnet and Chase Farm, Queen Mary’s and Sidcup and Bart’s.
Why London will get its own version of Millennium
Explaining why BT has ‘decoupled’ its development of Cerner Millennium from that in the South he says. “In an earlier phase in the programme there was an attempt to build what was known as a common solution, but it turned out that the timing and the nuance of the capabilities required in the South proved to be different from those required in London.”
“We have tried to address that issue by having our configuration be more London-centric rather than just copying the South”. He says this has involved working with users to identify priorities and differences.
“In the South they would now have a Release 0 from Cerner and we would have a London Configuration (London Configuration) 0, and when they have R1 we will have LC1. So we have altered our configuration to be more useful to the London culture.”
O’Connell says there are a “lot of differences” between the two clusters’ releases. “Before we even put out R0 we had 12 differences, and we’re making further adjustments as we go along.” Differences include issues such as reporting. “London is a very different environment to the South,” notes the BT Health boss.
Asked whether the differences are minor or purely around configuration the BT Health boss makes clear that BT now has “an entirely separate stream to Fujitsu, simply to be more responsive to our users”, the differences “are mostly around configuration with a little bit of code”.
BT he says is now developing its “own configuration capability, so we can configure the code ourselves”. This means that BT will get Cerner’s international baseline code and then configure it to meet the requirements of the London NHS. This capability runs into dozens of people.
‘Best of breed’ and interoperability
O’Connell has sought to reduce the risks of delivery by moving to a best of breed approach in London, with Cerner for acutes, Rio for community and INPS for primary care, he explains why. “If you look at a one size fits all approach there is more than one way to do that. You can have one vendor do it all or you can have a best of breed approach but make them interoperable.”
“You can de-risk things in two ways. One, take existing products versus to-be-developed products, so your eggs aren’t all in one basket; and two, each of the best of breed realises there is number two right behind them.” The approach he says, will deliver an interoperable solution “that provides a single view and maintains care pathways”.
He says that by going for an interoperability strategy, based on best of breed solutions, “it becomes much easier to connect with legacy systems because you have an interoperability strategy”. The advantage he says is that for the many trusts which have brought specialist systems or equipment over the years “this is a softer strategy that is more complementary to what they have in place right now because we can make it interoperate”.
Asked whether the approach is working O’Connell says the approach is more about strategy rather than the immediate position. “It’s intended as a long-term strategy with the immediate tactical gain of modifying an existing product rather than developing something new.”
Interoperability, he says, also offers a more flexible path for the future allowing innovation and new products to be adopted. “As products develop over time, either inline by a current supplier, or a better product from another supplier, it’s much easier to slot them in. So it helps de-risk cost growth, capability growth. So it makes it more flexible going forward and quite a bit more affordable than one size fits all.”
But first he says BT must begin the roll-out of acute trusts in earnest. “And once we get that critical mass of acutes we will start tying them together to make that single view you will begin to see across London. So our strategy is to begin to get capability off the ground in individual domains and then to tie it all together for a single view.” This single view being a summary of each patient’s record.
Turning to the New NHS Network (N3) programme O’Connell says BT finished early. “N3 programme finished two months early in January 2007, rather than March. We have delivered ahead of schedule and are now moving to the next phase where BT and CfH are trying to extract the next value out of it by putting in things VOIP, where people on the net can call each other for free for example.” He told EHI that he believed the opportunity now existed to make VOIP widespread.
The other major infrastructure project BT is responsible for is the spine, which O’Connell explains holds both the central records database used for the summary care record and provides the messaging trafficking for core NPfIT services such as ETP and Choose and Book. “It has delivered 14 of the past deliveries on or ahead of schedule. So we are delivering predictably and successfully, and it is forecast to do so until its conclusion.”
O’Connell says BT has now delivered elements of all the applications it has to deliver on the spine. “Right now it’s a question of more of, rather than ‘I wonder whether they can do this’, part.” He adds that even though the volume of traffic has increased dramatically, “generally the availability has increased dramatically… we are hovering at around circa 100% availability, but generally it’s a reliable and available system.”
The BT Health boss says that the sheer size of the spine programme has created challenges. “Scale is a challenge in and of itself. It has so many moving parts and such a configuration management issue that the technical issues pale compared to configuration management issues and the practicalities of configuration management. When you move to scale, technical brilliance becomes less important than configuration management brilliance, and that’s where some of the issues come in”.
O’Connell says that now the basic capabilities are in the spine [such as the personal demographic service (PDS)], which is due to complete next year, the aim is to extract “the next generation of value” such as secondary users services (SUS), providing data on trends or direction of travel to the clinical community. Questioned on the status of SUS O’Connell says: “It’s not in its end state but it’s en route.”
Questioned on the best known feature of the spine, the summary care record (SCR), O’Connell says. “In theory it’s quite a simple thing to do. In practice with the various constituencies that exist, from the BMA to the GPs and agencies involved, to the individuals him or herself, there is quite a convergence required to make it a proper record for all concerned, to maintain technical to ethical equities.
“And to a great extent I think the initial foundations are worked out. It’s in play right now. It’s in a three phase process. The first phase is a general stand-up of the system. The second phase will be a four to five month phase to increase the scale of the prototype. Then in the third phase, which should start around Christmas time, we should start to ramp up to full scale use.”
O’Connell explains that there are a lot of opinions about what the SCR record should hold and contain, and while these are being adjudicated it “will remain a relatively thin record”. “Then as we gradually move to phase three it will become a much thicker record”. But he stresses that the content and use of the record is a question for Connecting for Health. BT, he says, is on the “implementation side of that rather than the philosophy side of that”.
He says that there remains “a lag in people’s perceptions” on the spine, with most people remembering where it was two years ago rather than where it is today. “People are probably unaware of just how extensive the capabilities are, whether it be the demographics service, the SUS service or basic transaction service. So I think its incumbent on us to educate people about the capability we are providing.”
O’Connell says that what’s changed over the past two years are the performance, reliability and operational use of the spine, all now “tremendously greater”. Over 400m messages have now been processed on the spine.